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Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Cc","code_information":[{"code":"369","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5816.36,"maximum":30981.2,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25275.05},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25275.05},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20293.06},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19742.95},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7755.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7755.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5816.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30981.2},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19519.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5811.59,"10th_percentile":5811.59,"90th_percentile":5811.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8185.45,"10th_percentile":8185.45,"90th_percentile":8185.45,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8765.74,"10th_percentile":8765.74,"90th_percentile":8765.74,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":16216.42,"10th_percentile":16216.42,"90th_percentile":16216.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Cc","code_information":[{"code":"354","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9648.15,"maximum":52112.34,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":42514.25},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":42514.25},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34134.21},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33208.89},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12864.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12864.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9648.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52112.34},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32833.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":58223.75,"10th_percentile":58223.75,"90th_percentile":58223.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":34241.08,"10th_percentile":34241.08,"90th_percentile":34241.08,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9480.91,"10th_percentile":9480.91,"90th_percentile":9480.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12606.39,"10th_percentile":12606.39,"90th_percentile":12619.09,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"346","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6861.09,"maximum":36742.55,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":29975.27},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29975.27},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24066.81},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23414.4},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9148.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9148.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6861.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36742.55},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23149.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7954.26,"10th_percentile":7954.26,"90th_percentile":7954.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"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":7636.09,"10th_percentile":7636.09,"90th_percentile":7636.09,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Mcc","code_information":[{"code":"332","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20535.21,"maximum":112151.18,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":91495.09},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":91495.09},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":73460.38},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71469.0},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27380.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27380.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20535.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112151.18},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70660.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","code_information":[{"code":"324","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17897.0,"maximum":97602.23,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":79625.77},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":79625.77},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":63930.64},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62197.59},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23862.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23862.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17897.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97602.23},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61493.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22825.3,"10th_percentile":22825.3,"90th_percentile":22825.3,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses Without Cc/Mcc","code_information":[{"code":"316","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4029.66,"maximum":21128.05,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17236.67},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17236.67},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13839.13},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13463.97},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5372.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5372.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4029.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21128.05},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13311.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4697.98,"10th_percentile":4697.98,"90th_percentile":4697.98,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6961.07,"maximum":37293.9,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30425.08},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30425.08},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24427.96},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23765.76},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9281.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9281.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6961.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37293.9},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23496.78}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":50175.09,"10th_percentile":50175.09,"90th_percentile":50175.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":39388.57,"10th_percentile":39388.57,"90th_percentile":39388.57,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4722.12,"10th_percentile":4722.12,"90th_percentile":4722.12,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9011.41,"10th_percentile":8990.41,"90th_percentile":9211.42,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":31378.89,"10th_percentile":31378.89,"90th_percentile":31378.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Cc","code_information":[{"code":"300","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6194.38,"maximum":33065.81,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26975.73},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26975.73},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21658.51},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21071.38},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8259.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8259.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6194.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33065.81},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20832.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7963.22,"10th_percentile":7963.22,"90th_percentile":7963.22,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8021.91,"10th_percentile":8012.22,"90th_percentile":8114.82,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":8126.24,"10th_percentile":8126.24,"90th_percentile":8126.24,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5880.8,"10th_percentile":5880.8,"90th_percentile":5880.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6415.52,"10th_percentile":6415.52,"90th_percentile":6415.52,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":13656.57,"10th_percentile":13656.57,"90th_percentile":13656.57,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":49334.41,"10th_percentile":49334.41,"90th_percentile":49334.41,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis Without Cc/Mcc","code_information":[{"code":"290","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5420.38,"maximum":28797.46,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23493.52},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23493.52},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18862.68},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18351.35},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5420.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28797.46},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18143.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","code_information":[{"code":"282","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4259.95,"maximum":22398.02,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18272.74},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18272.74},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14670.98},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14273.27},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5679.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5679.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4259.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22398.02},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14111.73}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":18323.28,"10th_percentile":18323.28,"90th_percentile":18323.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":18323.28,"10th_percentile":18323.28,"90th_percentile":18323.28,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6120.31,"10th_percentile":6120.31,"90th_percentile":6120.31,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5543.77,"10th_percentile":5543.77,"90th_percentile":5543.77,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures Without Mcc","code_information":[{"code":"274","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18687.28,"maximum":101960.41,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":83181.26},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":83181.26},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":66785.3},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64974.87},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24916.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24916.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18687.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101960.41},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64239.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":128662.03,"10th_percentile":128662.03,"90th_percentile":128662.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":17112.98,"10th_percentile":17112.98,"90th_percentile":18843.18,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"24","median_amount":23009.21,"10th_percentile":22653.6,"90th_percentile":24421.16,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21354.12,"10th_percentile":21354.12,"90th_percentile":21354.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","code_information":[{"code":"266","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34620.48,"maximum":189827.19,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":154864.67},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":154864.67},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":124339.11},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":120968.49},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46160.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46160.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34620.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":189827.19},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":119599.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":190299.11,"10th_percentile":190299.11,"90th_percentile":190299.11,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44020.02,"10th_percentile":43999.02,"90th_percentile":45237.16,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement With Mcc","code_information":[{"code":"258","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17847.01,"maximum":97326.55,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":79400.87},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":79400.87},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":63750.07},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62021.91},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23796.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23796.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17847.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97326.55},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61319.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Mcc","code_information":[{"code":"180","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10117.72,"maximum":54701.85,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":44626.82},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":44626.82},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":35830.37},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34859.07},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13490.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13490.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10117.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54701.85},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34464.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":35461.11,"10th_percentile":35461.11,"90th_percentile":35461.11,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7430.15,"10th_percentile":7430.15,"90th_percentile":7430.15,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12988.24,"10th_percentile":12857.14,"90th_percentile":13218.39,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":52640.06,"10th_percentile":52640.06,"90th_percentile":52640.06,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Cc","code_information":[{"code":"167","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10327.78,"maximum":55860.32,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":45571.92},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":45571.92},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36589.18},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35597.31},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13770.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13770.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10327.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55860.32},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35194.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":47252.69,"10th_percentile":47252.69,"90th_percentile":47252.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","code_information":[{"code":"156","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4080.21,"maximum":21406.82,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17464.1},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17464.1},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14021.73},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13641.62},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5440.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5440.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4080.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21406.82},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13487.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":26834.32,"10th_percentile":26834.32,"90th_percentile":26834.32,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","code_information":[{"code":"148","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4675.59,"maximum":24690.17,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20142.72},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20142.72},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16172.36},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15733.96},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6234.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6234.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4675.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24690.17},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15555.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Mcc","code_information":[{"code":"140","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24155.8,"maximum":132117.67,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":107784.13},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":107784.13},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":86538.67},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":84192.76},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32207.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32207.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24155.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":132117.67},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":83239.89}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological Eye Disorders","code_information":[{"code":"123","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4684.02,"maximum":24736.64,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20180.62},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20180.62},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16202.8},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15763.57},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6245.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6245.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4684.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24736.64},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15585.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":20296.86,"10th_percentile":20296.86,"90th_percentile":20296.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":16296.12,"10th_percentile":16296.12,"90th_percentile":16296.12,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6212.61,"10th_percentile":6212.61,"90th_percentile":6212.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders With Mcc","code_information":[{"code":"073","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9209.48,"maximum":49693.19,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":40540.66},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":40540.66},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":32549.64},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31667.28},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12279.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12279.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9209.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49693.19},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31308.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11578.66,"10th_percentile":11578.66,"90th_percentile":11578.66,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5873.09,"maximum":31294.04,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25530.28},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25530.28},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20497.98},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19942.31},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7830.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7830.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5873.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31294.04},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19716.61}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":60207.88,"10th_percentile":60207.88,"90th_percentile":60207.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":20782.7,"10th_percentile":20782.7,"90th_percentile":25697.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"11","median_amount":20631.88,"10th_percentile":19315.62,"90th_percentile":40217.2,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7824.65,"10th_percentile":7824.65,"90th_percentile":7824.65,"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":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7999.02,"10th_percentile":7999.02,"90th_percentile":7999.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"32","median_amount":7615.16,"10th_percentile":6579.16,"90th_percentile":7768.82,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":11332.92,"10th_percentile":11332.92,"90th_percentile":11332.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"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":6553.68,"10th_percentile":6553.68,"90th_percentile":6553.68,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7636.68,"10th_percentile":7636.68,"90th_percentile":7645.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":17063.47,"10th_percentile":17063.47,"90th_percentile":17063.47},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":31294.04,"10th_percentile":30001.5,"90th_percentile":37747.59,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders Without Mcc","code_information":[{"code":"057","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7475.57,"maximum":40131.21,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":32739.81},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":32739.81},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26286.43},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25573.85},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9967.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9967.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7475.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40131.21},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25284.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":26121.88,"10th_percentile":26121.88,"90th_percentile":26121.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":25185.2,"10th_percentile":25185.2,"90th_percentile":27073.64,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":8647.85,"10th_percentile":5269.95,"90th_percentile":10434.21,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7293.98,"10th_percentile":7293.98,"90th_percentile":7293.98,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","code_information":[{"code":"040","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21886.05,"maximum":119600.67,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":97572.52},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":97572.52},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":78339.89},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":76216.23},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29181.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29181.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21886.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119600.67},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75353.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":51605.95,"10th_percentile":51605.95,"90th_percentile":51605.95,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27773.71,"10th_percentile":27773.71,"90th_percentile":27773.71,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Mcc","code_information":[{"code":"385","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9085.91,"maximum":49011.74,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":39984.72},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39984.72},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":32103.28},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31233.02},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12114.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12114.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9085.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49011.74},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30879.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9427.83,"10th_percentile":9427.83,"90th_percentile":9427.83,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9181.4,"maximum":49538.32,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":40414.31},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":40414.31},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":32448.2},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31568.58},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12241.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12241.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9181.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49538.32},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31211.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":40724.54,"10th_percentile":40724.54,"90th_percentile":40724.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":33596.56,"10th_percentile":33596.56,"90th_percentile":33596.56,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6265.11,"10th_percentile":6265.11,"90th_percentile":6265.11,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11995.13,"10th_percentile":10916.94,"90th_percentile":12393.49,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":10646.46,"10th_percentile":10646.46,"90th_percentile":10646.46,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8420.08,"10th_percentile":8420.08,"90th_percentile":8420.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":41902.19,"10th_percentile":41902.19,"90th_percentile":41902.19},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":67582.45,"10th_percentile":67582.45,"90th_percentile":67582.45,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Cc","code_information":[{"code":"406","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16488.3,"maximum":89833.7,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":73288.05},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":73288.05},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":58842.16},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57247.05},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21984.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21984.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16488.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89833.7},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56599.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20752.27,"10th_percentile":20752.27,"90th_percentile":20752.27,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20710.39,"10th_percentile":20710.39,"90th_percentile":20710.39,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":80162.09,"10th_percentile":80162.09,"90th_percentile":80162.09,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":20620.04,"10th_percentile":20620.04,"90th_percentile":20620.04,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures Without Cc/Mcc","code_information":[{"code":"254","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10205.9,"maximum":55188.16,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":45023.56},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":45023.56},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36148.91},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35168.98},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13607.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13607.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10205.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55188.16},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34770.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12906.15,"10th_percentile":12906.15,"90th_percentile":12906.15,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":51604.35,"10th_percentile":51604.35,"90th_percentile":51604.35,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Mcc","code_information":[{"code":"242","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18131.78,"maximum":98896.98,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":80682.06},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":80682.06},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":64778.72},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63022.68},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24175.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24175.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18131.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98896.98},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62309.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":18570.42,"10th_percentile":18570.42,"90th_percentile":18570.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":14245.2,"10th_percentile":14245.2,"90th_percentile":14245.2,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25020.22,"10th_percentile":23862.6,"90th_percentile":25020.58,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca Without Mcc","code_information":[{"code":"232","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34250.89,"maximum":187789.04,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":153201.9},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":153201.9},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":123004.09},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":119669.66},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45667.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45667.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34250.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":187789.04},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":118315.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","code_information":[{"code":"217","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37130.62,"maximum":203669.92,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":166157.83},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":166157.83},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":133406.26},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":129789.85},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49507.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49507.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37130.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":203669.92},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":128320.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":213146.01,"10th_percentile":213146.01,"90th_percentile":213146.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses Without Mcc","code_information":[{"code":"206","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5484.41,"maximum":29150.57,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23781.6},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23781.6},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19093.98},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18576.37},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7312.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7312.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5484.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29150.57},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18366.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":319.6,"10th_percentile":319.6,"90th_percentile":319.6,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8957.98,"10th_percentile":8957.98,"90th_percentile":8957.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"1 through 10","median_amount":36249.33,"10th_percentile":36249.33,"90th_percentile":36249.33,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease Without Cc/Mcc","code_information":[{"code":"198","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4221.2,"maximum":22184.3,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18098.37},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18098.37},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14530.98},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14137.07},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5628.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5628.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4221.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22184.3},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13977.07}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6420.17,"maximum":34311.01,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27991.58},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27991.58},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22474.13},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21864.89},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8560.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8560.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6420.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34311.01},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21617.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":22784.55,"10th_percentile":22784.55,"90th_percentile":23530.87,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5181.99,"10th_percentile":5181.99,"90th_percentile":5181.99,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8395.66,"10th_percentile":8394.38,"90th_percentile":8459.57,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6193.1,"10th_percentile":6193.1,"90th_percentile":6193.1,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6193.1,"10th_percentile":6193.1,"90th_percentile":6193.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"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":6887.92,"10th_percentile":6887.92,"90th_percentile":6887.92,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8846.57,"10th_percentile":8846.57,"90th_percentile":9634.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6888.87,"10th_percentile":6888.87,"90th_percentile":6888.87,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","code_information":[{"code":"099","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7850.78,"maximum":42200.34,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":34427.85},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":34427.85},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":27641.73},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26892.41},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10467.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10467.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7850.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42200.34},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26588.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Mcc","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10062.68,"maximum":54398.3,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":44379.17},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":44379.17},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":35631.54},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34665.63},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13416.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13416.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10062.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54398.3},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34273.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":32664.85,"10th_percentile":32664.85,"90th_percentile":32664.85,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6179.94,"10th_percentile":6179.94,"90th_percentile":9669.87,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9059.37,"10th_percentile":9059.37,"90th_percentile":13212.92,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":15312.4,"10th_percentile":15312.4,"90th_percentile":15312.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7943.77,"10th_percentile":7943.77,"90th_percentile":7943.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":42816.85,"10th_percentile":42816.85,"90th_percentile":42816.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Cc","code_information":[{"code":"083","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8038.37,"maximum":43234.91,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35271.87},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35271.87},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28319.39},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27551.7},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10717.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10717.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8038.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43234.91},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27239.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":35260.14,"10th_percentile":35260.14,"90th_percentile":35260.14,"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":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10380.37,"10th_percentile":10360.76,"90th_percentile":11339.36,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9422.97,"10th_percentile":9422.97,"90th_percentile":9422.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures Without Cc/Mcc","code_information":[{"code":"036","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11110.77,"maximum":60178.23,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":49094.56},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":49094.56},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":39417.47},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38348.93},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14814.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14814.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11110.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60178.23},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37914.91}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":37191.77,"10th_percentile":37191.77,"90th_percentile":37191.77,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13584.88,"10th_percentile":12312.88,"90th_percentile":13799.67,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":13734.14,"10th_percentile":13734.14,"90th_percentile":13734.14,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Mcc","code_information":[{"code":"028","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33945.9,"maximum":186107.09,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":151829.74},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":151829.74},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":121902.4},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":118597.83},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45261.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45261.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33945.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":186107.09},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":117255.58}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":113875.08,"10th_percentile":113875.08,"90th_percentile":113875.08,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":30601.56,"10th_percentile":30601.56,"90th_percentile":30601.56,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":55706.64,"10th_percentile":55706.64,"90th_percentile":55706.64,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":174996.49,"10th_percentile":174996.49,"90th_percentile":174996.49},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","code_information":[{"code":"020","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44395.96,"maximum":243736.08,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":198844.58},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":198844.58},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":159650.08},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":155322.24},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59194.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59194.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44395.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":243736.08},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":153564.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":124318.49,"10th_percentile":124318.49,"90th_percentile":124318.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":126399.84,"10th_percentile":126399.84,"90th_percentile":126399.84,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":32997.34,"10th_percentile":32997.34,"90th_percentile":32997.34,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":202924.44,"10th_percentile":202924.44,"90th_percentile":202924.44,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"1 through 10","median_amount":46021.59,"10th_percentile":46021.59,"90th_percentile":46021.59},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","code_information":[{"code":"011","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30833.06,"maximum":168940.75,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":137825.11},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":137825.11},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":110658.23},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":107658.48},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41110.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41110.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30833.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":168940.75},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":106440.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2222.76,"10th_percentile":2222.76,"90th_percentile":2222.76,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System Without Mcc","code_information":[{"code":"002","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":63846.98,"maximum":351002.51,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":286354.59},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":286354.59},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":229910.89},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":223678.4},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85129.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85129.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63846.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":351002.51},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":221146.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Cc","code_information":[{"code":"418","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9699.82,"maximum":52397.31,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":42746.73},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":42746.73},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34320.87},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33390.49},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12933.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12933.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9699.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52397.31},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33012.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":44323.3,"10th_percentile":44323.3,"90th_percentile":44323.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":33647.28,"10th_percentile":33647.28,"90th_percentile":35934.66,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":11159.59,"10th_percentile":11159.59,"90th_percentile":14115.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12313.8,"10th_percentile":12308.93,"90th_percentile":12327.5,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10707.16,"10th_percentile":10707.16,"90th_percentile":12340.04,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":10746.94,"10th_percentile":10746.94,"90th_percentile":10746.94,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":32488.45,"10th_percentile":32488.45,"90th_percentile":32488.45},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":48616.46,"10th_percentile":48616.46,"90th_percentile":50314.68,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":47167.48,"10th_percentile":47167.48,"90th_percentile":47167.48,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"426","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":62102.39,"maximum":341381.67,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":278505.72},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":278505.72},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":223609.13},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":217547.47},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82803.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82803.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62102.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":341381.67},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":215085.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":233661.87,"10th_percentile":233661.87,"90th_percentile":233661.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","code_information":[{"code":"435","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10514.83,"maximum":56891.78,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":46413.41},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":46413.41},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":37264.81},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36254.62},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14019.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14019.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10514.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56891.78},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35844.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":46107.64,"10th_percentile":46107.64,"90th_percentile":46107.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":10165.66,"10th_percentile":10165.66,"90th_percentile":10165.66,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13536.68,"10th_percentile":13529.31,"90th_percentile":14968.47,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":10165.66,"10th_percentile":10165.66,"90th_percentile":10165.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":15688.32,"10th_percentile":15688.32,"90th_percentile":15688.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":82715.43,"10th_percentile":82715.43,"90th_percentile":82715.43},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":36993.97,"10th_percentile":36993.97,"90th_percentile":36993.97,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"443","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4128.52,"maximum":21673.21,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17681.42},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17681.42},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14196.21},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13811.38},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5504.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5504.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4128.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21673.21},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13655.07}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":15780.04,"10th_percentile":15780.04,"90th_percentile":15780.04},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":19808.14,"10th_percentile":19808.14,"90th_percentile":19808.14,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Or Infection With Mcc","code_information":[{"code":"456","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":47398.71,"maximum":260295.32,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":212353.92},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":212353.92},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":170496.58},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":165874.71},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63198.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63198.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47398.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":260295.32},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":163997.39}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":61924.37,"10th_percentile":61924.37,"90th_percentile":61924.37,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Mcc","code_information":[{"code":"466","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29436.16,"maximum":161237.27,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":131540.46},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":131540.46},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":105612.36},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":102749.39},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39248.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39248.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29436.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":161237.27},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":101586.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":105612.36,"10th_percentile":105612.36,"90th_percentile":105612.36,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35715.63,"10th_percentile":35715.63,"90th_percentile":35715.63,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":37451.22,"10th_percentile":37451.22,"90th_percentile":37451.22,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc Or Insertion Of Antib","code_information":[{"code":"474","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24310.83,"maximum":132972.58,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":108481.58},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":108481.58},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":87098.65},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":84737.55},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32414.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32414.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24310.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":132972.58},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":83778.52}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":32650.37,"10th_percentile":32650.37,"90th_percentile":32650.37,"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":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","code_information":[{"code":"482","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9359.44,"maximum":50520.23,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":41215.37},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":41215.37},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33091.36},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32194.31},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12479.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12479.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9359.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50520.23},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31829.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":32186.47,"10th_percentile":32186.47,"90th_percentile":32186.47,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":10683.32,"10th_percentile":10683.32,"90th_percentile":10683.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","code_information":[{"code":"493","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14443.22,"maximum":78555.7,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":64087.25},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":64087.25},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":51454.93},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50060.08},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19257.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19257.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14443.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78555.7},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49493.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":86942.02,"10th_percentile":86942.02,"90th_percentile":117525.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":48713.89,"10th_percentile":48713.89,"90th_percentile":48713.89,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":27240.39,"10th_percentile":27240.39,"90th_percentile":44808.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":17744.54,"10th_percentile":17343.37,"90th_percentile":17782.53,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":14187.43,"10th_percentile":14187.43,"90th_percentile":14187.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"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":1033.56,"10th_percentile":1033.56,"90th_percentile":1033.56,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":13853.27,"10th_percentile":13853.27,"90th_percentile":13853.27,"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","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1033.56,"10th_percentile":1033.56,"90th_percentile":1033.56,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":78401.82,"10th_percentile":78401.82,"90th_percentile":78401.82},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"1 through 10","median_amount":71043.91,"10th_percentile":49200.42,"90th_percentile":81753.04,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Cc","code_information":[{"code":"501","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10017.17,"maximum":54147.4,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":44174.49},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":44174.49},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":35467.2},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34505.75},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13356.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13356.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10017.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54147.4},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34115.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13087.04,"10th_percentile":13087.04,"90th_percentile":13343.4,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","code_information":[{"code":"510","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17164.0,"maximum":93559.99,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":76328.04},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":76328.04},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":61282.92},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59621.65},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22885.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22885.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17164.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93559.99},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58946.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21074.21,"10th_percentile":21074.21,"90th_percentile":21074.21,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","code_information":[{"code":"518","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21190.13,"maximum":115762.87,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":94441.57},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":94441.57},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":75826.08},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":73770.56},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28253.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28253.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21190.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":115762.87},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":72935.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26280.51,"10th_percentile":26280.51,"90th_percentile":26280.51,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":59967.49,"10th_percentile":59967.49,"90th_percentile":59967.49,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis Without Mcc","code_information":[{"code":"536","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4734.57,"maximum":25015.41,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20408.05},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20408.05},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16385.4},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15941.22},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6312.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6312.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4734.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25015.41},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15760.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":16452.35,"10th_percentile":16452.35,"90th_percentile":16452.35,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6184.03,"10th_percentile":6184.03,"90th_percentile":6184.03,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"1 through 10","median_amount":23903.56,"10th_percentile":23903.56,"90th_percentile":23903.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis With Mcc","code_information":[{"code":"602","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8181.6,"maximum":44024.77,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35916.25},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35916.25},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28836.76},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28055.04},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10908.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10908.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8181.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44024.77},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27737.52}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":29808.6,"10th_percentile":29808.6,"90th_percentile":29808.6,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13019.44,"10th_percentile":13019.44,"90th_percentile":13089.76,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10910.1,"10th_percentile":10910.1,"90th_percentile":10910.1,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc Or Insertion Of","code_information":[{"code":"616","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19786.49,"maximum":108022.22,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":88126.6},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":88126.6},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":70755.86},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68837.79},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26381.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26381.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19786.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108022.22},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68058.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28488.51,"10th_percentile":28488.51,"90th_percentile":28488.51,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":23605.89,"10th_percentile":23605.89,"90th_percentile":23605.89,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":17377.66,"10th_percentile":17377.66,"90th_percentile":17377.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"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":28579.03,"10th_percentile":28579.03,"90th_percentile":28579.03,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":34464.1,"10th_percentile":34464.1,"90th_percentile":34464.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"624","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7230.11,"maximum":38777.6,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":31635.51},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31635.51},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25399.8},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24711.25},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9640.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9640.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7230.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38777.6},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24431.58}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Cc","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5232.22,"maximum":27759.8,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22646.97},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22646.97},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18183.0},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17690.09},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6976.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6976.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5232.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27759.8},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17489.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":24675.4,"10th_percentile":24675.4,"90th_percentile":33028.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":16012.56,"10th_percentile":16012.56,"90th_percentile":21355.76,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"11","median_amount":4576.89,"10th_percentile":4576.89,"90th_percentile":7139.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6539.69,"10th_percentile":6492.71,"90th_percentile":6900.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7377.52,"10th_percentile":4576.89,"90th_percentile":7377.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"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":6975.59,"10th_percentile":6975.59,"90th_percentile":6975.59,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4576.89,"10th_percentile":4576.89,"90th_percentile":4576.89,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":8234.55,"10th_percentile":8234.55,"90th_percentile":12160.71,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Cc","code_information":[{"code":"806","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4433.5,"maximum":23355.15,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19053.58},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19053.58},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15297.91},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14883.21},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5911.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5911.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4433.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23355.15},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14714.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"20","median_amount":15637.0,"10th_percentile":12952.25,"90th_percentile":16214.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"17","median_amount":11286.0,"10th_percentile":11286.0,"90th_percentile":11399.81,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"88","median_amount":3065.31,"10th_percentile":2703.04,"90th_percentile":3074.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4437.01,"10th_percentile":4437.01,"90th_percentile":4437.01,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4224.75,"10th_percentile":4224.75,"90th_percentile":4224.75,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4368.42,"10th_percentile":4368.42,"90th_percentile":4368.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":36836.54,"10th_percentile":36836.54,"90th_percentile":36836.54},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2978.08,"10th_percentile":2978.08,"90th_percentile":2978.08,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":12999.3,"10th_percentile":11262.0,"90th_percentile":19820.72,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":2927.37,"10th_percentile":2927.37,"90th_percentile":2927.37,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Mcc","code_information":[{"code":"814","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12143.7,"maximum":65874.53,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":53741.71},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":53741.71},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":43148.62},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41978.93},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16191.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16191.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12143.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65874.53},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41503.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","code_information":[{"code":"822","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6961.07,"maximum":37293.9,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30425.08},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30425.08},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24427.96},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23765.76},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9281.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9281.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6961.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37293.9},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23496.78}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":23204.53,"10th_percentile":23204.53,"90th_percentile":23204.53,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis With Mcc","code_information":[{"code":"650","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26605.29,"maximum":145625.87,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":118804.38},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":118804.38},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":95386.7},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":92800.93},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35473.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35473.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26605.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":145625.87},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":91750.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","code_information":[{"code":"658","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8914.6,"maximum":48067.01,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":39213.99},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39213.99},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31484.47},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30630.98},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11886.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11886.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8914.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48067.01},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30284.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":32920.38,"10th_percentile":32920.38,"90th_percentile":32920.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11177.58,"10th_percentile":11177.58,"90th_percentile":11177.58,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":29153.06,"10th_percentile":29153.06,"90th_percentile":29153.06},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Cc","code_information":[{"code":"666","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10023.92,"maximum":54184.57,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":44204.81},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":44204.81},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":35491.55},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34529.43},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13365.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13365.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10023.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54184.57},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34138.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12810.66,"10th_percentile":12810.66,"90th_percentile":12810.66,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Cc","code_information":[{"code":"674","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13333.9,"maximum":72438.14,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":59096.42},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":59096.42},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":47447.86},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46161.63},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17778.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17778.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13333.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72438.14},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45639.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15150.67,"10th_percentile":15004.94,"90th_percentile":17104.94,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":133331.3,"10th_percentile":133331.3,"90th_percentile":133331.3,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections With Mcc","code_information":[{"code":"689","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6715.62,"maximum":35940.29,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":29320.78},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29320.78},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23541.33},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22903.16},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8954.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8954.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6715.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35940.29},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22643.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6770.08,"10th_percentile":6770.08,"90th_percentile":6770.08,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":8762.78,"10th_percentile":8087.7,"90th_percentile":8870.06,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":7167.09,"10th_percentile":3106.9,"90th_percentile":8730.06,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13854.87,"10th_percentile":13854.87,"90th_percentile":13854.87,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Cc","code_information":[{"code":"699","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5899.49,"maximum":31439.63,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25649.05},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25649.05},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20593.34},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20035.09},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7865.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7865.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5899.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31439.63},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19808.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":16614.85,"10th_percentile":16614.85,"90th_percentile":21561.65,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7634.21,"10th_percentile":7634.21,"90th_percentile":7658.1,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":11050.48,"10th_percentile":11050.48,"90th_percentile":11050.48,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":7634.21,"10th_percentile":7634.21,"90th_percentile":7634.21,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":24600.61,"10th_percentile":24600.61,"90th_percentile":24600.61},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":26171.1,"10th_percentile":26171.1,"90th_percentile":26171.1,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","code_information":[{"code":"543","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5972.51,"maximum":31842.3,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25977.56},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25977.56},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20857.09},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20291.69},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7963.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7963.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5972.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31842.3},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20062.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7943.96,"10th_percentile":6829.78,"90th_percentile":8043.22,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7307.39,"10th_percentile":7307.39,"90th_percentile":7307.39,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":70076.4,"10th_percentile":70076.4,"90th_percentile":70076.4},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"1 through 10","median_amount":14335.48,"10th_percentile":14335.48,"90th_percentile":14335.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems With Mcc","code_information":[{"code":"551","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9612.76,"maximum":51917.2,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":42355.05},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":42355.05},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34006.39},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33084.54},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12817.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12817.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9612.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51917.2},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32710.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":264531.84,"10th_percentile":264531.84,"90th_percentile":264531.84,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6813.03,"10th_percentile":6813.03,"90th_percentile":6813.03,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11067.75,"10th_percentile":11050.47,"90th_percentile":12782.75,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"559","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10673.22,"maximum":57765.28,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":47126.02},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":47126.02},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":37836.96},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36811.26},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14230.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14230.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10673.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57765.28},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36394.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13871.85,"10th_percentile":13871.85,"90th_percentile":13871.85,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Male Reproductive System And Other O.R. Procedures For Malignancy With Cc/Mcc","code_information":[{"code":"715","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12764.92,"maximum":69300.37,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":56536.57},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":56536.57},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":45392.58},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44162.06},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17019.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17019.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12764.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69300.37},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43662.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy Without Mcc","code_information":[{"code":"726","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4253.77,"maximum":22363.95,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18244.94},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18244.94},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14648.66},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14251.56},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5671.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5671.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4253.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22363.95},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14090.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","code_information":[{"code":"737","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11772.43,"maximum":63827.09,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":52071.36},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":52071.36},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":41807.51},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40674.18},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15696.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15696.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11772.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63827.09},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40213.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":40543.51,"10th_percentile":40543.51,"90th_percentile":40543.51,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","code_information":[{"code":"564","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8868.54,"maximum":47813.01,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":39006.77},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39006.77},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31318.1},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30469.12},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11824.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11824.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8868.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47813.01},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30124.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11787.83,"10th_percentile":11787.83,"90th_percentile":11787.83,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"575","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10291.84,"maximum":55662.08,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":45410.19},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":45410.19},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36459.33},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35470.98},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13722.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13722.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10291.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55662.08},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35069.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy Without Cc/Mcc","code_information":[{"code":"583","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9884.06,"maximum":53413.29,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":43575.59},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":43575.59},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34986.35},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34037.93},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13178.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13178.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9884.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53413.29},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33652.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":11788.11,"10th_percentile":11788.11,"90th_percentile":11788.11,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Mcc","code_information":[{"code":"597","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9562.22,"maximum":51638.42,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":42127.62},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":42127.62},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33823.79},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32906.89},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12749.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12749.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9562.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51638.42},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32534.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"750","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8487.72,"maximum":45712.91,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":37293.47},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37293.47},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29942.51},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29130.82},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11316.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11316.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8487.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45712.91},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28801.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","code_information":[{"code":"761","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3402.82,"maximum":17671.24,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14416.54},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14416.54},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11574.87},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11261.1},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4537.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4537.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3402.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17671.24},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11133.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization Without Cc/Mcc","code_information":[{"code":"785","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5578.22,"maximum":29667.86,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24203.61},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24203.61},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19432.8},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18906.01},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7437.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7437.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5578.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29667.86},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18692.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":22805.0,"10th_percentile":22805.0,"90th_percentile":22805.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":20371.0,"10th_percentile":20371.0,"90th_percentile":34516.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4608.12,"10th_percentile":4608.12,"90th_percentile":5526.31,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4608.12,"10th_percentile":4608.12,"90th_percentile":4608.12,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5526.31,"10th_percentile":5526.31,"90th_percentile":5526.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":47550.62,"10th_percentile":47550.62,"90th_percentile":47550.62},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":26430.86,"10th_percentile":26430.86,"90th_percentile":26430.86},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":15948.0,"10th_percentile":15948.0,"90th_percentile":15948.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Term Neonate With Major Problems","code_information":[{"code":"793","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23618.27,"maximum":129153.36,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":105365.79},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":105365.79},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":84597.01},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82303.73},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31491.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31491.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23618.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":129153.36},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":81372.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"11","median_amount":8077.4,"10th_percentile":4377.6,"90th_percentile":21906.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"13","median_amount":11944.81,"10th_percentile":2824.36,"90th_percentile":56442.7,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"32","median_amount":5337.15,"10th_percentile":2248.63,"90th_percentile":9872.87,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4921.76,"10th_percentile":4921.76,"90th_percentile":4921.76,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":25433.84,"10th_percentile":25433.84,"90th_percentile":25433.84,"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":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":45378.43,"10th_percentile":45378.43,"90th_percentile":45378.43},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":51453.09,"10th_percentile":51453.09,"90th_percentile":51453.09},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","code_information":[{"code":"825","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7777.76,"maximum":41797.67,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":34099.34},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":34099.34},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":27377.98},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26635.81},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10370.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10370.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7777.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41797.67},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26334.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":12583.04,"10th_percentile":12583.04,"90th_percentile":12583.04,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","code_information":[{"code":"833","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3135.46,"maximum":16196.83,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13213.68},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13213.68},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":10609.12},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10321.52},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4180.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4180.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3135.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16196.83},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10204.71}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":10546.22,"10th_percentile":8244.79,"90th_percentile":30851.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":9916.0,"10th_percentile":9808.8,"90th_percentile":31825.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"22","median_amount":3031.51,"10th_percentile":2291.57,"90th_percentile":3074.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3074.68,"10th_percentile":3074.68,"90th_percentile":3074.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3074.68,"10th_percentile":3074.68,"90th_percentile":3074.68,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":44076.16,"10th_percentile":44076.16,"90th_percentile":77279.39},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":18903.06,"10th_percentile":18903.06,"90th_percentile":18903.06,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"1 through 10","median_amount":16418.4,"10th_percentile":16418.4,"90th_percentile":16418.4,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Cc","code_information":[{"code":"841","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9361.7,"maximum":50532.62,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":41225.48},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":41225.48},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33099.47},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32202.2},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12482.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12482.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9361.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50532.62},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31837.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11665.97,"10th_percentile":11665.97,"90th_percentile":11756.26,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Radiotherapy","code_information":[{"code":"849","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15417.17,"maximum":83926.76,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":68469.07},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":68469.07},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":54973.05},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53482.82},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20556.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20556.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15417.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83926.76},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52877.52}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections With Mcc","code_information":[{"code":"862","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10441.81,"maximum":56489.11,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":46084.9},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":46084.9},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":37001.05},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35998.01},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13922.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13922.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10441.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56489.11},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35590.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":46463.95,"10th_percentile":34822.1,"90th_percentile":244977.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":36960.11,"10th_percentile":36960.11,"90th_percentile":36960.11,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6354.16,"10th_percentile":6354.16,"90th_percentile":6354.16,"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":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":10557.61,"10th_percentile":10557.61,"90th_percentile":10557.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13653.86,"10th_percentile":13653.86,"90th_percentile":13653.86,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9215.72,"10th_percentile":9215.72,"90th_percentile":9215.72,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":58554.65,"10th_percentile":58554.65,"90th_percentile":58554.65},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":30788.44,"10th_percentile":30788.44,"90th_percentile":30788.44},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":17066.26,"10th_percentile":17066.26,"90th_percentile":17066.26,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis With Mv >96 Hours","code_information":[{"code":"870","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39020.68,"maximum":214093.01,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":174661.19},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":174661.19},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":140233.51},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":136432.02},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52027.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52027.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39020.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":214093.01},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":134887.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":187141.76,"10th_percentile":187141.76,"90th_percentile":187141.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":226888.43,"10th_percentile":226888.43,"90th_percentile":226888.43,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":17668.68,"10th_percentile":17668.68,"90th_percentile":17668.68,"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":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49716.53,"10th_percentile":49716.53,"90th_percentile":49716.53,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":51047.72,"10th_percentile":51047.72,"90th_percentile":51047.72,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":420227.59,"10th_percentile":420227.59,"90th_percentile":420227.59,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Organic Disturbances And Intellectual Disability","code_information":[{"code":"884","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9235.32,"maximum":49835.68,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":40656.9},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":40656.9},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":32642.97},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31758.08},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12313.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12313.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9235.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49835.68},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31398.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6172.48,"10th_percentile":6172.48,"90th_percentile":6172.48,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11810.29,"10th_percentile":11810.29,"90th_percentile":12393.12,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7293.98,"10th_percentile":7293.98,"90th_percentile":7293.98,"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":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Mcc","code_information":[{"code":"901","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23769.93,"maximum":129989.69,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":106048.08},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":106048.08},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":85144.82},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82836.69},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31693.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31693.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23769.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":129989.69},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":81899.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32591.6,"10th_percentile":32591.6,"90th_percentile":32591.6,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries Without Cc/Mcc","code_information":[{"code":"909","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7571.62,"maximum":40660.88,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33171.93},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33171.93},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26633.37},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25911.39},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10095.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10095.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7571.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40660.88},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25618.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":27885.69,"10th_percentile":27885.69,"90th_percentile":27885.69,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":23827.88,"10th_percentile":23827.88,"90th_percentile":23827.88},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":40419.82,"10th_percentile":40419.82,"90th_percentile":40419.82,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Cc","code_information":[{"code":"920","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5828.16,"maximum":31046.24,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25328.12},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25328.12},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20335.66},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19784.4},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7770.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7770.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5828.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31046.24},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19560.49}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":29481.53,"10th_percentile":29481.53,"90th_percentile":29481.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7271.27,"10th_percentile":7271.27,"90th_percentile":7271.27,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":5962.45,"10th_percentile":5962.45,"90th_percentile":5962.45,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7604.95,"10th_percentile":7604.95,"90th_percentile":7604.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":17791.89,"10th_percentile":17791.89,"90th_percentile":17791.89},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":12163.4,"10th_percentile":12163.4,"90th_percentile":12163.4,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","code_information":[{"code":"940","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13324.35,"maximum":72385.48,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":59053.46},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":59053.46},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":47413.36},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46128.07},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17765.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17765.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13324.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72385.48},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45606.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Factors Influencing Health Status","code_information":[{"code":"951","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3321.38,"maximum":17222.1,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14050.12},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14050.12},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11280.68},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10974.88},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4428.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4428.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3321.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17222.1},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10850.67}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":3947.14,"10th_percentile":3947.14,"90th_percentile":3947.14,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5051.74,"10th_percentile":5051.74,"90th_percentile":5051.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1569.82,"10th_percentile":1569.82,"90th_percentile":1569.82,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4339.28,"10th_percentile":4339.28,"90th_percentile":4339.28,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8892.39,"10th_percentile":8892.39,"90th_percentile":8892.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4123.14,"10th_percentile":4123.14,"90th_percentile":4123.14,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":4955.05,"10th_percentile":4955.05,"90th_percentile":4955.05},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"965","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5481.04,"maximum":29131.99,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23766.44},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23766.44},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19081.8},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18564.53},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7308.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7308.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5481.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29131.99},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18354.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"982","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14007.35,"maximum":76152.04,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":62126.3},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":62126.3},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":49880.51},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48528.33},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18676.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18676.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14007.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76152.04},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47979.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":81570.54,"10th_percentile":81570.54,"90th_percentile":81570.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":62865.56,"10th_percentile":62865.56,"90th_percentile":62865.56,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6360.35,"10th_percentile":6360.35,"90th_percentile":6360.35,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13293.89,"10th_percentile":13293.89,"90th_percentile":13293.89,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":54907.15,"10th_percentile":54907.15,"90th_percentile":54907.15,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","code_information":[{"code":"933","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22071.4,"maximum":120622.85,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":98406.43},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":98406.43},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":79009.42},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":76867.61},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29428.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29428.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22071.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":120622.85},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75997.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Mcc","code_information":[{"code":"377","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10465.96,"maximum":56622.3,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":46193.56},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":46193.56},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":37088.29},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36082.89},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13954.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13954.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10465.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56622.3},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35674.52}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":40614.6,"10th_percentile":40614.6,"90th_percentile":40614.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":10358.8,"10th_percentile":10358.8,"90th_percentile":10358.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9297.44,"10th_percentile":9297.44,"90th_percentile":30634.42,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13496.51,"10th_percentile":9055.34,"90th_percentile":13590.65,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":13468.51,"10th_percentile":12170.77,"90th_percentile":13475.85,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13475.87,"10th_percentile":13475.87,"90th_percentile":13475.87,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":56315.65,"10th_percentile":56315.65,"90th_percentile":56315.65,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Mcc","code_information":[{"code":"368","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9139.83,"maximum":49309.1,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":40227.31},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":40227.31},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":32298.06},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31422.51},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12186.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12186.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9139.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49309.1},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31066.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Mcc","code_information":[{"code":"353","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16498.41,"maximum":89889.45,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":73333.54},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":73333.54},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":58878.68},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57282.58},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21997.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21997.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16498.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89889.45},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56634.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1182.68,"10th_percentile":1182.68,"90th_percentile":1182.68,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Cc","code_information":[{"code":"345","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8650.04,"maximum":46608.08,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":38023.77},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":38023.77},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30528.86},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29701.27},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11533.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11533.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8650.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46608.08},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29365.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":11654.6,"10th_percentile":11654.6,"90th_percentile":11654.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10957.93,"10th_percentile":10957.93,"90th_percentile":10957.93,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"331","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9650.96,"maximum":52127.83,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":42526.88},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":42526.88},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34144.36},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33218.76},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12867.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12867.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9650.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52127.83},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32842.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":37176.35,"10th_percentile":37176.35,"90th_percentile":58314.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":33497.14,"10th_percentile":33497.14,"90th_percentile":53497.47,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":14193.49,"10th_percentile":14193.49,"90th_percentile":14193.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12266.69,"10th_percentile":12259.35,"90th_percentile":12356.59,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":11305.11,"10th_percentile":11305.11,"90th_percentile":11305.11,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":41537.42,"10th_percentile":41537.42,"90th_percentile":42798.26,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","code_information":[{"code":"323","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24504.61,"maximum":134041.22,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":109353.4},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":109353.4},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":87798.62},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":85418.55},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32672.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32672.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24504.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":134041.22},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":84451.81}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Cc","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5609.11,"maximum":29838.22,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24342.59},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24342.59},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19544.39},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19014.58},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7478.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7478.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5609.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29838.22},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18799.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":19524.1,"10th_percentile":19524.1,"90th_percentile":19524.1,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7294.47,"10th_percentile":7294.47,"90th_percentile":7294.47,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":31577.6,"10th_percentile":31577.6,"90th_percentile":31577.6},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":25964.84,"10th_percentile":25964.84,"90th_percentile":25964.84,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders Without Mcc","code_information":[{"code":"307","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5327.7,"maximum":28286.37,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23076.56},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23076.56},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18527.91},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18025.65},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7103.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7103.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5327.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28286.37},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17821.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":26402.29,"10th_percentile":26402.29,"90th_percentile":26402.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6960.45,"10th_percentile":6960.45,"90th_percentile":6960.45,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Mcc","code_information":[{"code":"299","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9369.0,"maximum":50572.88,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":41258.33},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":41258.33},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33125.85},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32227.87},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12492.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12492.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9369.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50572.88},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31863.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":15553.42,"10th_percentile":15553.42,"90th_percentile":15553.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":5654.9,"10th_percentile":5654.9,"90th_percentile":5654.9,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8430.79,"10th_percentile":8430.79,"90th_percentile":8430.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12021.94,"10th_percentile":11767.07,"90th_percentile":12028.94,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11864.23,"10th_percentile":11864.23,"90th_percentile":11864.23,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":70960.84,"10th_percentile":70960.84,"90th_percentile":70960.84},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Cc","code_information":[{"code":"289","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9785.76,"maximum":52871.23,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":43133.36},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":43133.36},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34631.29},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33692.5},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13047.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13047.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9785.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52871.23},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33311.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Cc","code_information":[{"code":"281","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5360.84,"maximum":28469.12,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23225.66},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23225.66},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18647.62},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18142.11},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7147.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7147.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5360.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28469.12},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17936.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":23293.89,"10th_percentile":23293.89,"90th_percentile":23382.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":18702.4,"10th_percentile":18702.4,"90th_percentile":19524.44,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7079.27,"10th_percentile":7079.27,"90th_percentile":7079.27,"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":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7457.94,"10th_percentile":7079.27,"90th_percentile":9632.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6923.34,"10th_percentile":6660.74,"90th_percentile":6988.55,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9974.38,"10th_percentile":9974.38,"90th_percentile":9974.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":5972.33,"10th_percentile":5972.33,"90th_percentile":5972.33},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"1 through 10","median_amount":27805.83,"10th_percentile":27805.83,"90th_percentile":27805.83,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures With Mcc","code_information":[{"code":"273","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23370.57,"maximum":127787.36,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":104251.39},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":104251.39},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":83702.27},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":81433.24},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31160.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31160.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23370.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":127787.36},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":80511.61}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":87638.0,"10th_percentile":87638.0,"90th_percentile":87638.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28792.0,"10th_percentile":28792.0,"90th_percentile":28792.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":98590.59,"10th_percentile":98590.59,"90th_percentile":98590.59},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Lead Procedures","code_information":[{"code":"265","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20521.17,"maximum":112073.75,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":91431.91},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":91431.91},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":73409.66},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71419.65},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27361.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27361.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20521.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112073.75},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70611.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","code_information":[{"code":"257","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6333.11,"maximum":33830.9,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27599.89},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27599.89},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22159.65},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21558.94},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8444.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8444.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6333.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33830.9},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21314.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations Without Cc/Mcc","code_information":[{"code":"179","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4439.12,"maximum":23386.13,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19078.85},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19078.85},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15318.2},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14902.95},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5918.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5918.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4439.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23386.13},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14734.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":5835.97,"10th_percentile":5835.97,"90th_percentile":5835.97,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5829.75,"10th_percentile":5829.75,"90th_percentile":5829.75,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":17274.1,"10th_percentile":17274.1,"90th_percentile":17274.1,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Mcc","code_information":[{"code":"166","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21192.38,"maximum":115775.26,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":94451.68},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":94451.68},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":75834.2},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":73778.46},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28256.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28256.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21192.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":115775.26},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":72943.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":79552.39,"10th_percentile":79552.39,"90th_percentile":79552.39,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28387.93,"10th_percentile":28387.93,"90th_percentile":28387.93,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","code_information":[{"code":"155","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5346.24,"maximum":28388.59,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23159.96},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23159.96},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18594.87},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18090.79},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7128.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7128.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5346.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28388.59},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17886.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4395.75,"10th_percentile":4395.75,"90th_percentile":4395.75,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7075.66,"10th_percentile":7075.66,"90th_percentile":7075.66,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Cc","code_information":[{"code":"147","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7340.2,"maximum":39384.71,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":32130.81},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":32130.81},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25797.46},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25098.14},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9786.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9786.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7340.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39384.71},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24814.09}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures","code_information":[{"code":"139","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7139.12,"maximum":38275.81,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":31226.14},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31226.14},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25071.12},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24391.48},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9518.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9518.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7139.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38275.81},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24115.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections Without Cc/Mcc","code_information":[{"code":"122","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4612.12,"maximum":24340.16,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19857.17},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19857.17},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15943.1},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15510.91},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6149.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6149.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4612.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24340.16},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15335.36}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders Without Cc/Mcc","code_information":[{"code":"072","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4445.86,"maximum":23423.3,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19109.17},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19109.17},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15342.54},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14926.63},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5927.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5927.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4445.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23423.3},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14757.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5750.04,"10th_percentile":5750.04,"90th_percentile":5750.04,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11493.83,"maximum":62290.73,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":50817.97},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":50817.97},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":40801.18},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39695.13},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15325.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15325.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11493.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62290.73},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39245.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":15491.1,"10th_percentile":15491.1,"90th_percentile":15491.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":79934.88,"10th_percentile":79934.88,"90th_percentile":79934.88,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":11332.92,"10th_percentile":11332.92,"90th_percentile":11332.92,"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":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":18918.91,"10th_percentile":18918.91,"90th_percentile":18918.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"25","median_amount":14680.72,"10th_percentile":12794.75,"90th_percentile":14890.23,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9529.33,"10th_percentile":9529.33,"90th_percentile":9529.33,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":16590.82,"10th_percentile":16590.82,"90th_percentile":16590.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13084.69,"10th_percentile":13084.69,"90th_percentile":13084.69,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":18908.67,"10th_percentile":18908.67,"90th_percentile":18908.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13081.79,"10th_percentile":13081.79,"90th_percentile":13859.89,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"1 through 10","median_amount":15022.54,"10th_percentile":15022.54,"90th_percentile":15022.54},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":69465.9,"10th_percentile":32092.91,"90th_percentile":75531.23},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":43376.91,"10th_percentile":43376.91,"90th_percentile":43376.91,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"1 through 10","median_amount":34452.21,"10th_percentile":34452.21,"90th_percentile":34452.21,"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."}]}]},{"description":"Degenerative Nervous System Disorders With Mcc","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13246.84,"maximum":71958.02,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":58704.74},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":58704.74},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":47133.38},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45855.67},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17662.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17662.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13246.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71958.02},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45336.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18597.96,"10th_percentile":18597.96,"90th_percentile":18597.96,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16852.53,"10th_percentile":16852.53,"90th_percentile":16852.53,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures Without Cc/Mcc","code_information":[{"code":"039","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6800.99,"maximum":36411.11,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":29704.89},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29704.89},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23849.72},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23203.19},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9067.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9067.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6800.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36411.11},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22940.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":24971.15,"10th_percentile":24971.15,"90th_percentile":24971.15,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8506.89,"10th_percentile":8152.31,"90th_percentile":8606.89,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":35255.75,"10th_percentile":35255.75,"90th_percentile":35255.75,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Cc","code_information":[{"code":"386","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5682.13,"maximum":30240.89,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24671.1},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24671.1},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19808.15},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19271.19},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7576.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7576.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5682.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30240.89},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19053.08}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6129.85,"10th_percentile":6129.85,"90th_percentile":6129.85,"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":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6129.85,"10th_percentile":6129.85,"90th_percentile":10759.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7531.37,"10th_percentile":7531.37,"90th_percentile":7531.37,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":18960.95,"10th_percentile":18960.95,"90th_percentile":18960.95,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":10534.46,"10th_percentile":10534.46,"90th_percentile":10534.46,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Cc","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5454.08,"maximum":28983.31,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23645.14},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23645.14},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18984.42},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18469.78},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7272.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7272.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5454.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28983.31},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18260.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":23786.65,"10th_percentile":23786.65,"90th_percentile":23786.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":16244.94,"10th_percentile":16244.94,"90th_percentile":16244.94,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5067.22,"10th_percentile":4583.14,"90th_percentile":5858.14,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6887.25,"10th_percentile":6096.56,"90th_percentile":7118.98,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8420.08,"10th_percentile":8420.08,"90th_percentile":8420.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7091.68,"10th_percentile":7091.68,"90th_percentile":7091.68,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":15062.1,"10th_percentile":15062.1,"90th_percentile":15062.1,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","code_information":[{"code":"407","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12665.5,"maximum":68752.11,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":56089.29},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":56089.29},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":45033.46},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43812.68},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16887.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16887.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12665.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68752.11},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43316.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":62472.43,"10th_percentile":62472.43,"90th_percentile":62472.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Cc","code_information":[{"code":"253","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14777.42,"maximum":80398.71,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":65590.81},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":65590.81},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":52662.13},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51234.55},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19703.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19703.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14777.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80398.71},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50654.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":51797.82,"10th_percentile":51797.82,"90th_percentile":51797.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18866.81,"10th_percentile":16794.81,"90th_percentile":19348.09,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":17200.02,"10th_percentile":17200.02,"90th_percentile":17200.02,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":17708.73,"10th_percentile":17708.73,"90th_percentile":17708.73,"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":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","code_information":[{"code":"241","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7974.34,"maximum":42881.79,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":34983.79},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":34983.79},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28088.09},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27326.67},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10632.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10632.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7974.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42881.79},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27017.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca With Mcc","code_information":[{"code":"231","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":47547.56,"maximum":261116.15,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":213023.57},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":213023.57},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":171034.24},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":166397.8},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63396.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63396.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47547.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":261116.15},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":164514.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":62160.82,"10th_percentile":62160.82,"90th_percentile":62160.82,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","code_information":[{"code":"216","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":55146.54,"maximum":303022.23,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":247211.36},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":247211.36},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":198483.23},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":193102.69},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73528.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73528.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55146.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":303022.23},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":190917.21}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":195811.17,"10th_percentile":195811.17,"90th_percentile":281559.17,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":38925.62,"10th_percentile":38925.62,"90th_percentile":38925.62,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":72046.55,"10th_percentile":72046.55,"90th_percentile":72721.55,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":232642.92,"10th_percentile":232642.92,"90th_percentile":232642.92},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":194420.69,"10th_percentile":194420.69,"90th_percentile":194420.69,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses With Mcc","code_information":[{"code":"205","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10482.81,"maximum":56715.23,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":46269.37},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":46269.37},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":37149.16},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36142.11},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13977.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13977.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10482.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56715.23},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35733.06}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13695.35,"10th_percentile":13695.35,"90th_percentile":13695.35,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":40575.67,"10th_percentile":40575.67,"90th_percentile":40575.67,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Cc","code_information":[{"code":"197","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5529.34,"maximum":29398.37,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23983.76},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23983.76},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19256.29},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18734.28},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7372.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7372.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5529.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29398.37},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18522.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Edema And Respiratory Failure","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7137.44,"maximum":38266.52,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":31218.56},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31218.56},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25065.03},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24385.56},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9516.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9516.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7137.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38266.52},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24109.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":25105.61,"10th_percentile":22784.55,"90th_percentile":71277.61,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5819.1,"10th_percentile":4062.1,"90th_percentile":8971.08,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9267.77,"10th_percentile":7510.77,"90th_percentile":9366.79,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8971.08,"10th_percentile":8971.08,"90th_percentile":10498.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8991.61,"10th_percentile":8822.12,"90th_percentile":9841.45,"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","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9225.79,"10th_percentile":7629.94,"90th_percentile":9324.79,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":1561.24,"10th_percentile":1561.24,"90th_percentile":1561.24},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8971.08,"10th_percentile":8971.08,"90th_percentile":8971.08,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":20860.8,"10th_percentile":17496.24,"90th_percentile":87081.56,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","code_information":[{"code":"098","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13088.44,"maximum":71084.53,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":57992.12},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":57992.12},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":46561.23},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45299.03},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17451.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17451.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13088.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71084.53},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44786.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":42587.6,"10th_percentile":42587.6,"90th_percentile":42587.6,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion Without Cc/Mcc","code_information":[{"code":"090","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4822.19,"maximum":25498.62,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20802.26},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20802.26},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16701.9},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16249.14},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6429.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6429.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4822.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25498.62},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16065.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Mcc","code_information":[{"code":"082","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13036.21,"maximum":70796.46,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":57757.11},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":57757.11},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":46372.54},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45115.46},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17381.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17381.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13036.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70796.46},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44604.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38600.54,"10th_percentile":38600.54,"90th_percentile":38600.54,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Cc","code_information":[{"code":"035","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13625.42,"maximum":74045.74,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":60407.94},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":60407.94},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":48500.85},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47186.08},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18167.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18167.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13625.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74045.74},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46652.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":50781.39,"10th_percentile":50781.39,"90th_percentile":50781.39,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16859.06,"10th_percentile":16859.06,"90th_percentile":16859.06,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":74475.11,"10th_percentile":74475.11,"90th_percentile":74475.11},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","code_information":[{"code":"027","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14369.08,"maximum":78146.83,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":63753.68},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":63753.68},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":51187.12},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49799.52},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19158.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19158.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14369.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78146.83},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49235.91}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":53593.96,"10th_percentile":50069.19,"90th_percentile":63261.19,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":21693.0,"10th_percentile":21693.0,"90th_percentile":21693.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18250.39,"10th_percentile":18250.39,"90th_percentile":18250.39,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":15528.01,"10th_percentile":15528.01,"90th_percentile":15528.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":69060.47,"10th_percentile":65130.7,"90th_percentile":72794.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas, Islet Cell And Kidney Transplant With Hemodialysis","code_information":[{"code":"019","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40272.1,"maximum":220994.24,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":180291.34},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":180291.34},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":144753.9},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":140829.87},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53696.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53696.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40272.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":220994.24},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":139236.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas Or Islet Cell Transplant","code_information":[{"code":"010","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40502.96,"maximum":222267.31,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":181329.94},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":181329.94},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":145587.78},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":141641.14},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54003.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54003.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40502.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":222267.31},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":140038.09}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System With Mcc","code_information":[{"code":"001","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":157603.28,"maximum":868040.3,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":708163.95},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":708163.95},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":568576.91},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":553163.76},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":210137.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":210137.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":157603.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":868040.3},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":546903.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","code_information":[{"code":"419","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7869.87,"maximum":42305.66,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":34513.77},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":34513.77},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":27710.72},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26959.53},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10493.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10493.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7869.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42305.66},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26654.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":33295.75,"10th_percentile":31895.75,"90th_percentile":35786.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":26732.79,"10th_percentile":25830.84,"90th_percentile":26732.79,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":11159.59,"10th_percentile":11159.59,"90th_percentile":11159.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9902.84,"10th_percentile":9819.65,"90th_percentile":9916.84,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9178.77,"10th_percentile":9178.77,"90th_percentile":9178.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":59238.34,"10th_percentile":38869.2,"90th_percentile":59772.7,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","code_information":[{"code":"427","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40743.92,"maximum":223596.14,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":182414.02},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":182414.02},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":146458.18},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":142487.95},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54325.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54325.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40743.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":223596.14},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":140875.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":139888.91,"10th_percentile":139888.91,"90th_percentile":139888.91,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":53644.08,"10th_percentile":53644.08,"90th_percentile":53644.08,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":55250.44,"10th_percentile":55250.44,"90th_percentile":55250.44,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":293253.52,"10th_percentile":293253.52,"90th_percentile":293253.52,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Cc","code_information":[{"code":"436","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6551.6,"maximum":35035.82,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28582.9},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28582.9},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22948.89},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22326.78},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8735.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8735.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6551.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35035.82},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22074.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8063.94,"10th_percentile":8063.94,"90th_percentile":8063.94,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8423.05,"10th_percentile":8423.05,"90th_percentile":8423.05,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":33988.8,"10th_percentile":33988.8,"90th_percentile":33988.8,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Mcc","code_information":[{"code":"444","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9583.56,"maximum":51756.13,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":42223.64},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":42223.64},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33900.89},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32981.9},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12778.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12778.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9583.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51756.13},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32608.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":34174.79,"10th_percentile":34174.79,"90th_percentile":34174.79,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12529.34,"10th_percentile":11124.75,"90th_percentile":12603.09,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10919.16,"10th_percentile":10919.16,"90th_percentile":11547.4,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Or Infection With Cc","code_information":[{"code":"457","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33692.02,"maximum":184707.02,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":150687.54},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":150687.54},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":120985.34},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":117705.63},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44922.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44922.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33692.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":184707.02},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":116373.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41803.38,"10th_percentile":41803.38,"90th_percentile":41803.38,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":42179.9,"10th_percentile":42179.9,"90th_percentile":42179.9,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Cc","code_information":[{"code":"467","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20006.67,"maximum":109236.44,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":89117.18},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":89117.18},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":71551.19},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69611.56},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26675.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26675.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20006.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":109236.44},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68823.71}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":69493.88,"10th_percentile":69493.88,"90th_percentile":69493.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":69493.88,"10th_percentile":69493.88,"90th_percentile":69493.88,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":14025.81,"10th_percentile":14025.81,"90th_percentile":14025.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25228.38,"10th_percentile":23520.22,"90th_percentile":25559.92,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":18722.16,"10th_percentile":18722.16,"90th_percentile":18722.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"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":23721.82,"10th_percentile":23721.82,"90th_percentile":23721.82,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24495.38,"10th_percentile":24495.38,"90th_percentile":24495.38,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":81752.12,"10th_percentile":81752.12,"90th_percentile":81752.12,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","code_information":[{"code":"475","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12980.6,"maximum":70489.81,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":57506.94},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":57506.94},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":46171.68},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44920.04},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17307.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17307.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12980.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70489.81},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44411.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","code_information":[{"code":"483","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15767.66,"maximum":85859.6,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":70045.91},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":70045.91},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":56239.08},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54714.53},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21023.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21023.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15767.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85859.6},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54095.29}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18824.7,"10th_percentile":18824.7,"90th_percentile":18845.7,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":18391.07,"10th_percentile":18391.07,"90th_percentile":18391.07,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","code_information":[{"code":"494","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11468.56,"maximum":62151.34,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":50704.26},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":50704.26},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":40709.88},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39606.3},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15291.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15291.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11468.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62151.34},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39158.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":38252.88,"10th_percentile":38252.88,"90th_percentile":38252.88,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":14187.43,"10th_percentile":14187.43,"90th_percentile":14187.43,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":14187.43,"10th_percentile":14187.43,"90th_percentile":14187.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"1 through 10","median_amount":23666.69,"10th_percentile":23666.69,"90th_percentile":23666.69,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures Without Cc/Mcc","code_information":[{"code":"502","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7758.1,"maximum":41689.25,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":34010.89},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":34010.89},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":27306.97},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26566.72},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10344.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10344.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7758.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41689.25},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26266.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":26230.3,"10th_percentile":26230.3,"90th_percentile":26230.3,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","code_information":[{"code":"511","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11878.03,"maximum":64409.42,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":52546.44},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":52546.44},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":42188.95},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41045.28},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15837.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15837.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11878.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64409.42},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40580.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14564.27,"10th_percentile":14564.27,"90th_percentile":14564.27,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Cc","code_information":[{"code":"519","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11433.17,"maximum":61956.2,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":50545.05},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":50545.05},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":40582.06},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39481.95},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15244.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15244.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11433.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61956.2},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39035.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":49420.96,"10th_percentile":49420.96,"90th_percentile":49420.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":13074.04,"10th_percentile":13074.04,"90th_percentile":13074.04,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14627.59,"10th_percentile":14250.98,"90th_percentile":14936.98,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"1 through 10","median_amount":31944.7,"10th_percentile":31944.7,"90th_percentile":31944.7,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","code_information":[{"code":"537","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5558.56,"maximum":29559.44,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24115.16},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24115.16},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19361.79},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18836.93},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7411.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7411.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5558.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29559.44},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18623.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis Without Mcc","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5090.12,"maximum":26976.13,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22007.64},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22007.64},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17669.69},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17190.7},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6786.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6786.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5090.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26976.13},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16996.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":22119.32,"10th_percentile":22119.32,"90th_percentile":22119.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":51379.31,"10th_percentile":17870.55,"90th_percentile":60007.28,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4906.38,"10th_percentile":4493.5,"90th_percentile":8897.69,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":6627.08,"10th_percentile":5587.33,"90th_percentile":6650.05,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4753.62,"10th_percentile":4753.62,"90th_percentile":4753.62,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":5264.34,"10th_percentile":5264.34,"90th_percentile":6671.94,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6616.35,"10th_percentile":6616.35,"90th_percentile":6616.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":25033.59,"10th_percentile":22364.25,"90th_percentile":68123.28},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3744.59,"10th_percentile":3744.59,"90th_percentile":3744.59,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"1 through 10","median_amount":26462.14,"10th_percentile":26462.14,"90th_percentile":26462.14,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"617","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10703.55,"maximum":57932.54,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":47262.48},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":47262.48},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":37946.52},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36917.85},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14271.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14271.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10703.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57932.54},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36500.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":39190.23,"10th_percentile":39190.23,"90th_percentile":39190.23,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":13013.14,"10th_percentile":10996.41,"90th_percentile":32650.37,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14347.67,"10th_percentile":14339.88,"90th_percentile":14427.63,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","code_information":[{"code":"625","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17161.76,"maximum":93547.6,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":76317.93},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":76317.93},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":61274.81},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59613.75},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22882.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22882.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17161.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93547.6},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58939.06}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":19508.79,"10th_percentile":19508.79,"90th_percentile":19508.79,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Mcc","code_information":[{"code":"799","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25636.4,"maximum":140282.68,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":114445.3},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":114445.3},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":91886.85},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":89395.96},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34181.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34181.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25636.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":140282.68},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":88384.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":120153.8,"10th_percentile":120153.8,"90th_percentile":120153.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":77624.81,"10th_percentile":77624.81,"90th_percentile":77624.81,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","code_information":[{"code":"807","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3985.29,"maximum":20883.35,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17037.03},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17037.03},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13678.84},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13308.03},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5313.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5313.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3985.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20883.35},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13157.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"57","median_amount":15637.0,"10th_percentile":12971.27,"90th_percentile":16214.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"67","median_amount":11286.0,"10th_percentile":10503.57,"90th_percentile":14872.49,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2978.08,"10th_percentile":2978.08,"90th_percentile":2978.08,"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":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2730.07,"10th_percentile":2730.07,"90th_percentile":2730.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"179","median_amount":2703.04,"10th_percentile":2628.85,"90th_percentile":3065.31,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3065.31,"10th_percentile":2978.08,"90th_percentile":3154.62,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"11","median_amount":2978.08,"10th_percentile":2703.04,"90th_percentile":3065.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3324.31,"10th_percentile":3324.31,"90th_percentile":3324.31,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"12","median_amount":20311.18,"10th_percentile":17789.82,"90th_percentile":22772.83},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":14596.54,"10th_percentile":14596.54,"90th_percentile":16645.26},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"33","median_amount":11553.25,"10th_percentile":10976.56,"90th_percentile":15229.88,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":14907.84,"10th_percentile":8581.97,"90th_percentile":20444.13,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"1 through 10","median_amount":16319.67,"10th_percentile":16319.67,"90th_percentile":16319.67,"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."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Cc","code_information":[{"code":"815","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5893.88,"maximum":31408.65,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25623.78},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25623.78},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20573.05},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20015.35},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7858.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7858.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5893.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31408.65},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19788.82}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8482.32,"10th_percentile":8482.32,"90th_percentile":8482.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":31473.7,"10th_percentile":31473.7,"90th_percentile":31473.7,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes Without Cc/Mcc","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3687.59,"maximum":19241.67,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15697.72},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15697.72},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12603.53},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12261.87},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4916.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4916.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3687.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19241.67},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12123.09}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5492.27,"10th_percentile":5492.27,"90th_percentile":5492.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":4877.56,"10th_percentile":4877.56,"90th_percentile":4877.56,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":14112.0,"10th_percentile":14112.0,"90th_percentile":14112.0},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis Without Mcc","code_information":[{"code":"651","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21013.2,"maximum":114787.16,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":93645.57},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":93645.57},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":75186.98},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":73148.79},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28017.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28017.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21013.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":114787.16},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":72320.91}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","code_information":[{"code":"659","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14470.18,"maximum":78704.38,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":64208.54},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":64208.54},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":51552.32},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50154.83},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19293.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19293.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14470.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78704.38},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49587.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":31314.54,"10th_percentile":31314.54,"90th_percentile":31314.54,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8660.33,"10th_percentile":8660.33,"90th_percentile":8660.33,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18904.67,"10th_percentile":18218.67,"90th_percentile":19071.41,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy Without Cc/Mcc","code_information":[{"code":"667","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6411.75,"maximum":34264.55,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27953.67},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27953.67},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22443.69},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21835.28},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8549.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8549.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6411.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34264.55},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21588.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","code_information":[{"code":"675","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9417.86,"maximum":50842.37,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":41478.18},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":41478.18},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33302.36},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32399.59},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12557.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12557.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9417.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50842.37},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32032.91}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections Without Mcc","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4745.24,"maximum":25074.26,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20456.07},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20456.07},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16423.95},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15978.72},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6326.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6326.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4745.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25074.26},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15797.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":12723.08,"10th_percentile":12723.08,"90th_percentile":12723.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4165.28,"10th_percentile":4165.28,"90th_percentile":4165.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4873.59,"10th_percentile":4873.59,"90th_percentile":4873.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6057.1,"10th_percentile":5408.77,"90th_percentile":6101.77,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":4557.01,"10th_percentile":4557.01,"90th_percentile":4557.01,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6486.05,"10th_percentile":6486.05,"90th_percentile":6486.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4431.87,"10th_percentile":4431.87,"90th_percentile":4431.87,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5848.3,"10th_percentile":5848.3,"90th_percentile":5848.3,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","code_information":[{"code":"700","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4073.47,"maximum":21369.65,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17433.77},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17433.77},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13997.38},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13617.94},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5431.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5431.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4073.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21369.65},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13463.81}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5097.75,"10th_percentile":4689.87,"90th_percentile":5269.06,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":11993.25,"10th_percentile":11993.25,"90th_percentile":11993.25},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":11034.72,"10th_percentile":11034.72,"90th_percentile":11034.72,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","code_information":[{"code":"544","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4436.88,"maximum":23373.74,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19068.74},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19068.74},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15310.08},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14895.05},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5915.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5915.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4436.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23373.74},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14726.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5755.62,"10th_percentile":5755.62,"90th_percentile":5755.62,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems Without Mcc","code_information":[{"code":"552","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5597.87,"maximum":29776.27,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24292.05},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24292.05},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19503.82},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18975.1},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7463.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7463.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5597.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29776.27},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18760.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":25187.98,"10th_percentile":25187.98,"90th_percentile":33211.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":14278.0,"10th_percentile":14278.0,"90th_percentile":14278.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5358.37,"10th_percentile":5358.37,"90th_percentile":5358.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6481.15,"10th_percentile":6481.15,"90th_percentile":6481.15,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7247.82,"10th_percentile":7230.7,"90th_percentile":7431.7,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6481.15,"10th_percentile":6481.15,"90th_percentile":6481.15,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6481.15,"10th_percentile":6481.15,"90th_percentile":6481.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"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":7253.34,"10th_percentile":7253.34,"90th_percentile":7253.34,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6808.91,"10th_percentile":6808.91,"90th_percentile":6808.91,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5637.18,"10th_percentile":5637.18,"90th_percentile":5637.18,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":28891.68,"10th_percentile":28891.68,"90th_percentile":28891.68,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"1 through 10","median_amount":42010.95,"10th_percentile":42010.95,"90th_percentile":42010.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"560","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6523.52,"maximum":34880.95,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28456.55},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28456.55},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22847.44},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22228.09},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8698.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8698.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6523.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34880.95},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21976.52}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8548.53,"10th_percentile":8548.53,"90th_percentile":8548.53,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Male Reproductive System And Other O.R. Procedures For Malignancy Without Cc/Mcc","code_information":[{"code":"716","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8460.76,"maximum":45564.23,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":37172.17},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37172.17},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29845.12},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29036.07},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11281.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11281.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8460.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45564.23},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28707.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System With Mcc","code_information":[{"code":"727","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8527.6,"maximum":45932.83,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":37472.88},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37472.88},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30086.56},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29270.96},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11370.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11370.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8527.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45932.83},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28939.68}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"738","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8446.72,"maximum":45486.79,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":37109.0},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37109.0},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29794.4},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28986.72},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11262.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11262.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8446.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45486.79},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28658.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","code_information":[{"code":"565","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5671.46,"maximum":30182.04,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24623.09},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24623.09},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19769.6},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19233.68},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7561.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7561.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5671.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30182.04},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19016.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":7662.16,"10th_percentile":7662.16,"90th_percentile":7662.16,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9491.25,"10th_percentile":9491.25,"90th_percentile":9491.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"576","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27727.53,"maximum":151814.67,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":123853.32},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":123853.32},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":99440.45},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":96744.79},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36970.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36970.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27727.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":151814.67},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":95649.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","code_information":[{"code":"584","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12222.34,"maximum":66308.18,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":54095.49},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":54095.49},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":43432.66},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42255.28},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16296.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16296.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12222.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66308.18},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41777.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Cc","code_information":[{"code":"598","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6552.73,"maximum":35042.02,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28587.95},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28587.95},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22952.95},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22330.73},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8736.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8736.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6552.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35042.02},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22078.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Mcc","code_information":[{"code":"754","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10542.91,"maximum":57046.66,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":46539.76},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":46539.76},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":37366.25},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36353.32},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14057.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14057.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10542.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57046.66},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35941.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13410.72,"10th_percentile":13410.72,"90th_percentile":13410.72,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","code_information":[{"code":"768","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6217.4,"maximum":33192.81,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27079.33},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27079.33},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21741.69},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21152.31},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8289.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8289.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6217.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33192.81},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20912.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":15637.0,"10th_percentile":12999.54,"90th_percentile":22295.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"18","median_amount":11286.0,"10th_percentile":11286.0,"90th_percentile":13385.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"15","median_amount":3661.04,"10th_percentile":3062.19,"90th_percentile":6189.97,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6189.97,"10th_percentile":6189.97,"90th_percentile":6189.97,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":27492.94,"10th_percentile":27492.94,"90th_percentile":41099.7},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":23580.63,"10th_percentile":23580.63,"90th_percentile":23580.63},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":11262.0,"10th_percentile":11262.0,"90th_percentile":11262.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Mcc","code_information":[{"code":"786","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9463.36,"maximum":51093.26,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":41682.87},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":41682.87},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33466.71},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32559.48},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12617.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12617.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9463.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51093.26},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32190.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":22805.0,"10th_percentile":22805.0,"90th_percentile":28670.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":21328.0,"10th_percentile":20371.0,"90th_percentile":22805.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5669.97,"10th_percentile":5669.97,"90th_percentile":5669.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5726.67,"10th_percentile":5726.67,"90th_percentile":5726.67,"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":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"19","median_amount":5669.97,"10th_percentile":4548.78,"90th_percentile":7784.31,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":66492.83,"10th_percentile":66492.83,"90th_percentile":66492.83},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7467.65,"10th_percentile":7467.65,"90th_percentile":7467.65,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":35619.98,"10th_percentile":35619.98,"90th_percentile":35619.98,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":134275.94,"10th_percentile":134275.94,"90th_percentile":134275.94,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonate With Other Significant Problems","code_information":[{"code":"794","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8488.28,"maximum":45716.0,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":37295.99},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37295.99},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29944.54},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29132.79},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11317.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11317.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8488.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45716.0},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28803.07}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"25","median_amount":3648.0,"10th_percentile":2769.6,"90th_percentile":9120.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"25","median_amount":5040.0,"10th_percentile":3024.0,"90th_percentile":11019.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2248.63,"10th_percentile":2248.63,"90th_percentile":2248.63,"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":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"89","median_amount":2248.63,"10th_percentile":1569.82,"90th_percentile":5184.92,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1569.82,"10th_percentile":1569.82,"90th_percentile":1569.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":5494.21,"10th_percentile":5494.21,"90th_percentile":5494.21},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5143.73,"10th_percentile":5143.73,"90th_percentile":5143.73,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":3116.26,"10th_percentile":3116.26,"90th_percentile":3151.59},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"14","median_amount":5320.22,"10th_percentile":1797.88,"90th_percentile":9171.88,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","code_information":[{"code":"826","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26472.74,"maximum":144894.86,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":118208.01},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":118208.01},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":94907.88},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":92335.09},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35296.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35296.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26472.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":144894.86},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":91290.07}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Mcc","code_information":[{"code":"834","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31034.14,"maximum":170049.65,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":138729.77},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":138729.77},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":111384.58},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":108365.14},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41378.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41378.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31034.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":170049.65},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":107138.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":136674.61,"10th_percentile":136674.61,"90th_percentile":136674.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":256496.58,"10th_percentile":256496.58,"90th_percentile":256496.58,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40637.18,"10th_percentile":40544.78,"90th_percentile":40659.54,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":149208.77,"10th_percentile":149208.77,"90th_percentile":149208.77},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","code_information":[{"code":"842","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5873.66,"maximum":31297.14,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25532.81},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25532.81},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20500.01},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19944.29},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7831.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7831.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5873.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31297.14},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19718.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":26581.51,"10th_percentile":26581.51,"90th_percentile":26581.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7694.71,"10th_percentile":7694.71,"90th_percentile":7694.71,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Other Procedures","code_information":[{"code":"850","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48837.18,"maximum":268228.01,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":218825.57},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":218825.57},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":175692.6},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":170929.87},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65116.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65116.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48837.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":268228.01},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":168995.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections Without Mcc","code_information":[{"code":"863","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5803.45,"maximum":30909.95,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25216.93},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25216.93},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20246.39},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19697.55},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7737.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7737.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5803.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30909.95},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19474.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":25267.47,"10th_percentile":25267.47,"90th_percentile":25267.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6354.16,"10th_percentile":6354.16,"90th_percentile":6354.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7557.4,"10th_percentile":7557.4,"90th_percentile":7586.01,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":8652.27,"10th_percentile":8652.27,"90th_percentile":8652.27},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":17284.26,"10th_percentile":17284.26,"90th_percentile":17284.26,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","code_information":[{"code":"871","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11109.08,"maximum":60168.94,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":49086.98},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":49086.98},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":39411.38},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38343.01},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14812.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14812.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11109.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60168.94},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37909.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"11","median_amount":49582.27,"10th_percentile":29515.41,"90th_percentile":69284.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"23","median_amount":39809.05,"10th_percentile":30769.78,"90th_percentile":82541.95,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":18870.5,"10th_percentile":18870.5,"90th_percentile":18870.5,"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":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"14","median_amount":17668.68,"10th_percentile":6169.67,"90th_percentile":18870.5,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"90","median_amount":14535.84,"10th_percentile":11891.31,"90th_percentile":14692.39,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":17668.68,"10th_percentile":17668.68,"90th_percentile":18870.5,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":18870.5,"10th_percentile":18870.5,"90th_percentile":18870.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"21","median_amount":13055.46,"10th_percentile":10248.83,"90th_percentile":14562.36,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9138.34,"10th_percentile":9138.34,"90th_percentile":9138.34,"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","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":12886.38,"10th_percentile":791.64,"90th_percentile":14562.38,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":17668.68,"10th_percentile":17668.68,"90th_percentile":17668.68,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":36459.88,"10th_percentile":36459.88,"90th_percentile":111156.81},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"11","median_amount":45080.08,"10th_percentile":34855.62,"90th_percentile":70720.05,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Psychoses","code_information":[{"code":"885","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8043.99,"maximum":43265.88,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35297.14},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35297.14},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28339.68},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27571.44},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10725.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10725.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8043.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43265.88},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27259.39}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"18","median_amount":16193.85,"10th_percentile":7320.95,"90th_percentile":72193.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"25","median_amount":21468.15,"10th_percentile":8998.7,"90th_percentile":29672.22,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7600.36,"10th_percentile":7600.36,"90th_percentile":11637.25,"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":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"61","median_amount":6274.4,"10th_percentile":5210.01,"90th_percentile":9139.26,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":10008.13,"10th_percentile":3287.9,"90th_percentile":21570.19,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5364.38,"10th_percentile":5364.38,"90th_percentile":5364.38,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"17","median_amount":7600.36,"10th_percentile":5876.24,"90th_percentile":11736.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":8408.33,"10th_percentile":8365.21,"90th_percentile":10007.69,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7600.36,"10th_percentile":7600.36,"90th_percentile":8378.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9939.92,"10th_percentile":8359.52,"90th_percentile":136487.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2894.45,"10th_percentile":2894.45,"90th_percentile":2894.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":53628.34,"10th_percentile":53628.34,"90th_percentile":79319.83},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":16350.76,"10th_percentile":3479.3,"90th_percentile":25565.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"1 through 10","median_amount":4989.42,"10th_percentile":4989.42,"90th_percentile":4989.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Wound Debridements For Injuries With Cc","code_information":[{"code":"902","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10951.82,"maximum":59301.64,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":48379.42},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":48379.42},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":38843.29},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37790.32},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14602.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14602.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10951.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59301.64},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37362.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12405.38,"10th_percentile":12405.38,"90th_percentile":12405.38,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":18871.45,"10th_percentile":18871.45,"90th_percentile":18871.45,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury With Mcc","code_information":[{"code":"913","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9379.66,"maximum":50631.74,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":41306.34},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":41306.34},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33164.4},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32265.37},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12506.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12506.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9379.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50631.74},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31900.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9121.62,"10th_percentile":9121.62,"90th_percentile":9121.62,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment Without Cc/Mcc","code_information":[{"code":"921","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4065.04,"maximum":21323.19,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17395.87},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17395.87},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13966.95},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13588.33},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5420.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5420.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4065.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21323.19},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13434.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5051.6,"10th_percentile":5051.6,"90th_percentile":5051.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5267.74,"10th_percentile":5267.74,"90th_percentile":5267.74,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":9612.37,"10th_percentile":9612.37,"90th_percentile":9612.37,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","code_information":[{"code":"941","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11587.64,"maximum":62808.01,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":51239.98},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":51239.98},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":41140.01},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40024.77},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15450.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15450.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11587.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62808.01},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39571.78}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14277.22,"10th_percentile":14277.22,"90th_percentile":14277.22,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy For Multiple Significant Trauma","code_information":[{"code":"955","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38005.72,"maximum":208495.82,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":170094.9},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":170094.9},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":136567.29},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":132865.18},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50674.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50674.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38005.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":208495.82},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":131361.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures With Mcc","code_information":[{"code":"969","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34580.6,"maximum":189607.27,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":154685.25},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":154685.25},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":124195.06},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":120828.34},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46107.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46107.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34580.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":189607.27},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":119460.84}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"983","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9825.64,"maximum":53091.15,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":43312.78},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":43312.78},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34775.35},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33832.65},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13100.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13100.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9825.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53091.15},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33449.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":12772.67,"10th_percentile":12772.67,"90th_percentile":12772.67,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":698.52,"10th_percentile":698.52,"90th_percentile":698.52,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn Without Skin Graft Or Inhalation Injury","code_information":[{"code":"934","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12614.95,"maximum":68473.34,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":55861.86},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":55861.86},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":44850.86},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43635.03},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16819.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16819.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12614.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68473.34},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43141.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7692.2,"10th_percentile":7692.2,"90th_percentile":7692.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Mcc","code_information":[{"code":"374","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12211.1,"maximum":66246.23,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":54044.95},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":54044.95},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":43392.08},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42215.8},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16281.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16281.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12211.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66246.23},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41738.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":103439.2,"10th_percentile":103439.2,"90th_percentile":103439.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15656.35,"10th_percentile":10644.56,"90th_percentile":15953.3,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","code_information":[{"code":"371","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10157.6,"maximum":54921.77,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":44806.24},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":44806.24},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":35974.43},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34999.22},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13543.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13543.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10157.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54921.77},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34603.11}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":28593.48,"10th_percentile":28593.48,"90th_percentile":28593.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":14540.36,"10th_percentile":14540.36,"90th_percentile":14540.36,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8808.68,"10th_percentile":8808.68,"90th_percentile":8808.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13091.44,"10th_percentile":13091.44,"90th_percentile":13091.44,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8808.68,"10th_percentile":8808.68,"90th_percentile":8808.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8808.68,"10th_percentile":8808.68,"90th_percentile":8808.68,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Mcc","code_information":[{"code":"356","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24871.94,"maximum":136066.98,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":111006.06},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":111006.06},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":89125.52},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":86709.48},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33162.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33162.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24871.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":136066.98},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":85728.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":220171.36,"10th_percentile":220171.36,"90th_percentile":220171.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19888.31,"10th_percentile":19888.31,"90th_percentile":32634.02,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":337917.71,"10th_percentile":337917.71,"90th_percentile":337917.71},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Cc","code_information":[{"code":"348","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7549.71,"maximum":40540.08,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33073.38},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33073.38},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26554.24},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25834.4},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10066.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10066.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7549.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40540.08},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25542.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9373.81,"10th_percentile":9373.81,"90th_percentile":9373.81,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":37134.6,"10th_percentile":37134.6,"90th_percentile":37134.6,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection Without Cc/Mcc","code_information":[{"code":"334","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9398.2,"maximum":50733.95,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":41389.73},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":41389.73},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33231.35},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32330.51},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12530.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12530.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9398.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50733.95},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31964.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Mcc","code_information":[{"code":"326","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28211.7,"maximum":154484.72,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":126031.6},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":126031.6},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":101189.36},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":98446.29},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37615.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37615.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28211.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":154484.72},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":97332.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":91584.91,"10th_percentile":91584.91,"90th_percentile":91584.91,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":141122.88,"10th_percentile":141122.88,"90th_percentile":141122.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37372.07,"10th_percentile":37372.07,"90th_percentile":37372.07,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy Without Intraluminal Device","code_information":[{"code":"318","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13803.46,"maximum":75027.65,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":61208.99},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":61208.99},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":49144.02},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47811.81},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18404.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18404.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13803.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75027.65},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47270.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3378.11,"maximum":17534.95,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14305.35},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14305.35},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11485.6},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11174.25},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4504.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4504.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3378.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17534.95},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11047.78}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4722.12,"10th_percentile":4722.12,"90th_percentile":4722.12,"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":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4635.92,"10th_percentile":4635.92,"90th_percentile":4635.92,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4070.4,"10th_percentile":3922.18,"90th_percentile":4276.94,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis With Mcc","code_information":[{"code":"302","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6919.51,"maximum":37064.69,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30238.08},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30238.08},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24277.82},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23619.69},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9226.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9226.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6919.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37064.69},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23352.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9045.32,"10th_percentile":9045.32,"90th_percentile":9045.32,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Cc","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4967.11,"maximum":26297.78,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21454.23},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21454.23},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17225.36},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16758.41},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6622.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6622.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4967.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26297.78},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16568.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5482.59,"10th_percentile":5482.59,"90th_percentile":5482.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6598.88,"10th_percentile":6598.88,"90th_percentile":6598.88,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4875.13,"10th_percentile":4875.13,"90th_percentile":4875.13,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Cc","code_information":[{"code":"284","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4086.39,"maximum":21440.9,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17491.89},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17491.89},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14044.05},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13663.34},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5448.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5448.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4086.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21440.9},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13508.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","code_information":[{"code":"276","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33936.35,"maximum":186054.44,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":151786.78},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":151786.78},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":121867.91},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":118564.28},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45248.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45248.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33936.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":186054.44},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":117222.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","code_information":[{"code":"268","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38830.28,"maximum":213042.95,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":173804.53},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":173804.53},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":139545.71},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":135762.87},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51773.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51773.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38830.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":213042.95},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":134226.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":135278.94,"10th_percentile":135278.94,"90th_percentile":135278.94,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Mcc","code_information":[{"code":"260","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18468.79,"maximum":100755.48,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":82198.26},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":82198.26},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":65996.06},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64207.02},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24625.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24625.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18468.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100755.48},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63480.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1325.65,"10th_percentile":1325.65,"90th_percentile":1325.65,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms Without Cc/Mcc","code_information":[{"code":"182","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4432.39,"maximum":23348.96,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19048.53},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19048.53},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15293.85},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14879.26},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5909.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5909.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4432.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23348.96},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14710.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","code_information":[{"code":"173","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16916.3,"maximum":92193.99,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":75213.63},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":75213.63},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":60388.18},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58751.16},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22555.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22555.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16916.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92193.99},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58086.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Cc","code_information":[{"code":"158","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5308.6,"maximum":28181.06,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22990.65},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22990.65},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18458.93},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17958.54},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7078.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7078.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5308.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28181.06},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17755.29}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":32150.01,"10th_percentile":32150.01,"90th_percentile":32150.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":10634.13,"10th_percentile":10634.13,"90th_percentile":10634.13,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7053.91,"10th_percentile":7053.91,"90th_percentile":7053.91,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis With Mcc","code_information":[{"code":"150","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7677.22,"maximum":41243.21,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33647.01},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33647.01},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":27014.8},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26282.48},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10236.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10236.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7677.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41243.21},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25985.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":8686.02,"10th_percentile":8686.02,"90th_percentile":8686.02,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures Without Cc/Mcc","code_information":[{"code":"142","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9165.1,"maximum":49448.49,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":40341.03},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":40341.03},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":32389.36},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31511.34},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12220.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12220.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9165.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49448.49},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31154.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12203.19,"10th_percentile":12203.19,"90th_percentile":12203.19,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye Without Mcc","code_information":[{"code":"125","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4511.02,"maximum":23782.61,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19402.31},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19402.31},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15577.89},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15155.6},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6014.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6014.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4511.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23782.61},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14984.08}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":15327.37,"10th_percentile":15327.37,"90th_percentile":15327.37,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6227.12,"10th_percentile":6227.12,"90th_percentile":6227.12,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":6246.66,"10th_percentile":6246.66,"90th_percentile":6246.66,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6212.61,"10th_percentile":6212.61,"90th_percentile":6212.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures Without Cc/Mcc","code_information":[{"code":"114","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7797.98,"maximum":41909.18,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":34190.31},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":34190.31},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":27451.02},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26706.87},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10397.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10397.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7797.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41909.18},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26404.61}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction With Mcc","code_information":[{"code":"067","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8447.84,"maximum":45492.98,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":37114.05},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37114.05},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29798.45},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28990.67},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11263.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11263.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8447.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45492.98},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28662.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Cc","code_information":[{"code":"059","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7168.33,"maximum":38436.88,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":31357.54},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31357.54},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25176.62},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24494.13},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9557.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9557.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7168.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38436.88},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24216.91}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9955.57,"10th_percentile":9955.57,"90th_percentile":9955.57,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9036.16,"10th_percentile":9036.16,"90th_percentile":9036.16,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","code_information":[{"code":"042","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9902.6,"maximum":53515.51,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":43658.98},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":43658.98},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":35053.31},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34103.07},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13203.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13203.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9902.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53515.51},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33717.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer With Mcc","code_information":[{"code":"383","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7953.56,"maximum":42767.18,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":34890.29},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":34890.29},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28013.02},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27253.64},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10604.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10604.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7953.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42767.18},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26945.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6147.81,"10th_percentile":6147.81,"90th_percentile":6147.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","code_information":[{"code":"391","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7322.24,"maximum":39285.59,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":32049.94},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":32049.94},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25732.54},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25034.97},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9762.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9762.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7322.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39285.59},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24751.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":32459.32,"10th_percentile":32459.32,"90th_percentile":32459.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":52105.2,"10th_percentile":52105.2,"90th_percentile":52105.2,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":16435.27,"10th_percentile":16435.27,"90th_percentile":16435.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":9566.21,"10th_percentile":9132.75,"90th_percentile":9608.21,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":9636.52,"10th_percentile":9636.52,"90th_percentile":9636.52,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8009.08,"10th_percentile":8009.08,"90th_percentile":8009.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8765.74,"10th_percentile":8765.74,"90th_percentile":8765.74,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":22432.44,"10th_percentile":22432.44,"90th_percentile":22432.44},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","code_information":[{"code":"402","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22780.81,"maximum":124534.99,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":101598.04},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":101598.04},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":81571.92},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":79360.65},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30374.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30374.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22780.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":124534.99},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":78462.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":79374.63,"10th_percentile":79374.63,"90th_percentile":79374.63,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29076.17,"10th_percentile":29076.17,"90th_percentile":29076.17,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","code_information":[{"code":"256","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9735.21,"maximum":52592.45,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":42905.93},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":42905.93},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34448.69},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33514.85},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12980.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12980.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9735.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52592.45},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33135.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12564.81,"10th_percentile":12564.81,"90th_percentile":12564.81,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","code_information":[{"code":"244","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10350.82,"maximum":55987.31,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":45675.53},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":45675.53},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36672.37},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35678.24},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13801.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13801.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10350.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55987.31},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35274.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13404.78,"10th_percentile":13376.78,"90th_percentile":13638.59,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11727.3,"10th_percentile":11727.3,"90th_percentile":11727.3,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","code_information":[{"code":"234","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30881.37,"maximum":169207.13,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":138042.43},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":138042.43},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":110832.72},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":107828.24},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41175.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41175.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30881.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":169207.13},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":106607.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":193547.45,"10th_percentile":193547.45,"90th_percentile":193547.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":107941.54,"10th_percentile":107941.54,"90th_percentile":107941.54,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39137.06,"10th_percentile":38312.18,"90th_percentile":39472.93,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":94998.51,"10th_percentile":94998.51,"90th_percentile":94998.51,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","code_information":[{"code":"219","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43325.97,"maximum":237835.34,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":194030.64},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":194030.64},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":155785.03},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":151561.96},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57767.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57767.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43325.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":237835.34},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":149846.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":153786.14,"10th_percentile":148711.15,"90th_percentile":156986.14,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":42930.8,"10th_percentile":42930.8,"90th_percentile":42930.8,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":56801.59,"10th_percentile":56407.35,"90th_percentile":57292.45,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":82356.05,"10th_percentile":82356.05,"90th_percentile":82356.05,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":202624.19,"10th_percentile":202624.19,"90th_percentile":202624.19},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":225916.06,"10th_percentile":225916.06,"90th_percentile":225916.06,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support <=96 Hours","code_information":[{"code":"208","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15637.35,"maximum":85140.98,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":69459.65},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":69459.65},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":55768.37},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54256.59},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20849.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20849.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15637.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85140.98},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53642.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":141262.63,"10th_percentile":141262.63,"90th_percentile":141262.63,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":24427.46,"10th_percentile":24427.46,"90th_percentile":24427.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19851.97,"10th_percentile":19809.97,"90th_percentile":34108.91,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":15417.92,"10th_percentile":15417.92,"90th_percentile":15620.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19843.49,"10th_percentile":19843.49,"90th_percentile":19843.49,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19809.98,"10th_percentile":19809.98,"90th_percentile":19809.98,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":14114.66,"10th_percentile":14114.66,"90th_percentile":14114.66},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":15620.93,"10th_percentile":15620.93,"90th_percentile":15620.93,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":47011.72,"10th_percentile":47011.72,"90th_percentile":47011.72},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"1 through 10","median_amount":128807.29,"10th_percentile":128807.29,"90th_percentile":128807.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Cc","code_information":[{"code":"200","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6372.99,"maximum":34050.82,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27779.31},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27779.31},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22303.7},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21699.08},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8497.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8497.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6372.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34050.82},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21453.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":19355.88,"10th_percentile":19355.88,"90th_percentile":19355.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":19027.16,"10th_percentile":19027.16,"90th_percentile":19027.16,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":10214.85,"10th_percentile":10214.85,"90th_percentile":10214.85,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8296.23,"10th_percentile":8092.49,"90th_percentile":8352.16,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8011.64,"10th_percentile":8011.64,"90th_percentile":8011.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7490.1,"10th_percentile":7490.1,"90th_percentile":7490.1,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8266.27,"10th_percentile":8266.27,"90th_percentile":8266.27,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":31961.18,"10th_percentile":31961.18,"90th_percentile":31961.18},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3804.43,"maximum":19885.95,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16223.34},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16223.34},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13025.54},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12672.44},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5072.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5072.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3804.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19885.95},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12529.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Cc","code_information":[{"code":"375","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6992.53,"maximum":37467.36,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30566.59},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30566.59},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24541.57},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23876.29},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9323.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9323.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6992.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37467.36},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23606.07}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":23128.0,"10th_percentile":23128.0,"90th_percentile":23128.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":24929.09,"10th_percentile":24929.09,"90th_percentile":24929.09,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6646.72,"10th_percentile":6646.72,"90th_percentile":6646.72,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9176.1,"10th_percentile":9176.1,"90th_percentile":9239.71,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders Without Cc/Mcc","code_information":[{"code":"370","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4134.69,"maximum":21707.28,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17709.22},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17709.22},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14218.53},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13833.09},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5512.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5512.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4134.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21707.28},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13676.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8716.55,"10th_percentile":8716.55,"90th_percentile":8716.55,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","code_information":[{"code":"355","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7753.04,"maximum":41661.38,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33988.15},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33988.15},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":27288.71},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26548.96},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10337.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10337.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7753.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41661.38},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26248.48}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9483.91,"10th_percentile":9483.91,"90th_percentile":9483.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10136.05,"10th_percentile":10136.05,"90th_percentile":10136.05,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Mcc","code_information":[{"code":"347","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13092.38,"maximum":71106.21,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":58009.81},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":58009.81},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":46575.43},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45312.85},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17456.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17456.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13092.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71106.21},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44800.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8411.27,"10th_percentile":8411.27,"90th_percentile":8411.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Cc","code_information":[{"code":"333","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13354.12,"maximum":72549.65,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":59187.39},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":59187.39},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":47520.9},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46232.69},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17805.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17805.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13354.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72549.65},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45709.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":49755.35,"10th_percentile":49755.35,"90th_percentile":49755.35,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy Without Intraluminal Device","code_information":[{"code":"325","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18230.63,"maximum":99442.14,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":81126.81},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":81126.81},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":65135.81},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63370.09},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24307.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24307.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18230.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99442.14},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62652.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","code_information":[{"code":"317","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37755.22,"maximum":207114.34,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":168967.86},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":168967.86},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":135662.4},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":131984.82},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50340.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50340.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37755.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":207114.34},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":130491.06}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47640.57,"10th_percentile":47640.57,"90th_percentile":47640.57,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Cc","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4330.72,"maximum":22788.31,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18591.14},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18591.14},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14926.62},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14521.98},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5774.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5774.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4330.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22788.31},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14357.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":18682.11,"10th_percentile":18682.11,"90th_percentile":18682.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":43479.67,"10th_percentile":43479.67,"90th_percentile":43479.67,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4722.12,"10th_percentile":4722.12,"90th_percentile":4722.12,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"23","median_amount":5377.87,"10th_percentile":4628.94,"90th_percentile":5671.94,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":4810.57,"10th_percentile":4810.57,"90th_percentile":4810.57,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5580.89,"10th_percentile":5580.89,"90th_percentile":5580.89,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4635.92,"10th_percentile":4635.92,"90th_percentile":4635.92,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":5271.49,"10th_percentile":5271.49,"90th_percentile":5271.49},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders Without Cc/Mcc","code_information":[{"code":"301","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4240.85,"maximum":22292.71,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18186.82},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18186.82},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14601.99},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14206.16},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5654.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5654.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4240.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22292.71},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14045.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5389.24,"10th_percentile":5389.24,"90th_percentile":5389.24,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":20394.31,"10th_percentile":20394.31,"90th_percentile":20394.31},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Mcc","code_information":[{"code":"291","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7409.3,"maximum":39765.71,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":32441.63},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":32441.63},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26047.02},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25340.93},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9879.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9879.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7409.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39765.71},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25054.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":89176.4,"10th_percentile":89176.4,"90th_percentile":89176.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":26473.09,"10th_percentile":26473.09,"90th_percentile":59453.09,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7651.94,"10th_percentile":5482.59,"90th_percentile":15248.5,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"45","median_amount":9718.99,"10th_percentile":8003.99,"90th_percentile":9815.35,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8131.75,"10th_percentile":8131.75,"90th_percentile":15248.5,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8131.75,"10th_percentile":8131.75,"90th_percentile":8131.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8119.63,"10th_percentile":7628.59,"90th_percentile":9801.35,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8076.53,"10th_percentile":8071.23,"90th_percentile":9768.16,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8131.75,"10th_percentile":8131.75,"90th_percentile":8131.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":56301.35,"10th_percentile":56301.35,"90th_percentile":56301.35},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":17724.64,"10th_percentile":17724.64,"90th_percentile":22050.84,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":6549.65,"10th_percentile":6549.65,"90th_percentile":6549.65,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Mcc","code_information":[{"code":"283","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11324.2,"maximum":61355.28,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":50054.82},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":50054.82},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":40188.45},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39099.01},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15098.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15098.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11324.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61355.28},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38656.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":17822.6,"10th_percentile":17822.6,"90th_percentile":17822.6,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14451.62,"10th_percentile":14451.62,"90th_percentile":14493.83,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","code_information":[{"code":"275","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40248.52,"maximum":220864.14,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":180185.21},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":180185.21},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":144668.69},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":140746.97},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53664.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53664.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40248.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":220864.14},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":139154.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":143382.36,"10th_percentile":143382.36,"90th_percentile":143382.36,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":51912.43,"10th_percentile":51912.43,"90th_percentile":52351.58,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","code_information":[{"code":"267","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26938.93,"maximum":147465.78,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":120305.42},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":120305.42},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":96591.87},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":93973.43},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35918.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35918.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26938.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":147465.78},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":92909.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":95453.66,"10th_percentile":95453.66,"90th_percentile":95453.66,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":37626.23,"10th_percentile":37626.23,"90th_percentile":37626.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":34605.09,"10th_percentile":34593.07,"90th_percentile":35201.56,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":30106.76,"10th_percentile":30106.76,"90th_percentile":30106.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33132.9,"10th_percentile":33132.9,"90th_percentile":33132.9,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement Without Mcc","code_information":[{"code":"259","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11556.18,"maximum":62634.55,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":51098.47},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":51098.47},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":41026.39},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39914.23},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15408.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15408.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11556.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62634.55},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39462.49}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Cc","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6214.04,"maximum":33174.23,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27064.17},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27064.17},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21729.52},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21140.47},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8285.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8285.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6214.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33174.23},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20901.21}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"168","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7873.24,"maximum":42324.24,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":34528.93},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":34528.93},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":27722.89},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26971.37},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10497.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10497.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7873.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42324.24},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26666.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Mcc","code_information":[{"code":"157","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9841.37,"maximum":53177.88,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":43383.54},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":43383.54},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34832.16},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33887.92},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13121.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13121.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9841.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53177.88},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33504.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dysequilibrium","code_information":[{"code":"149","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4420.03,"maximum":23280.81,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18992.93},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18992.93},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15249.21},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14835.83},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5893.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5893.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4420.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23280.81},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14667.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":18889.33,"10th_percentile":18889.33,"90th_percentile":18889.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":11595.3,"10th_percentile":11595.3,"90th_percentile":11595.3,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5646.55,"10th_percentile":5646.55,"90th_percentile":5646.55,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5781.61,"10th_percentile":5760.39,"90th_percentile":5781.61,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":5671.41,"10th_percentile":5671.41,"90th_percentile":5671.41,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":844.86,"10th_percentile":844.86,"90th_percentile":844.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5688.11,"10th_percentile":5688.11,"90th_percentile":5688.11,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":11110.24,"10th_percentile":11110.24,"90th_percentile":11110.24},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":24689.68,"10th_percentile":24689.68,"90th_percentile":24689.68,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"1 through 10","median_amount":36838.39,"10th_percentile":36838.39,"90th_percentile":36838.39,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Cc","code_information":[{"code":"141","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12449.25,"maximum":67559.57,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":55116.4},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":55116.4},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":44252.34},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43052.73},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16599.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16599.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12449.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67559.57},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42565.48}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","code_information":[{"code":"124","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7630.04,"maximum":40983.02,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33434.74},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33434.74},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26844.38},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26116.67},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10173.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10173.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7630.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40983.02},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25821.09}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":9673.89,"10th_percentile":9673.89,"90th_percentile":9673.89,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures With Cc/Mcc","code_information":[{"code":"113","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13404.11,"maximum":72825.32,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":59412.3},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":59412.3},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":47701.47},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46408.36},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17872.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17872.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13404.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72825.32},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45883.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4042.58,"maximum":21199.29,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17294.79},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17294.79},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13885.79},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13509.37},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5390.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5390.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4042.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21199.29},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13356.48}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":13591.42,"10th_percentile":13256.33,"90th_percentile":22766.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":14489.0,"10th_percentile":14489.0,"90th_percentile":14489.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5225.92,"10th_percentile":4595.49,"90th_percentile":5281.49,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6208.71,"10th_percentile":6208.71,"90th_percentile":6208.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":15445.55,"10th_percentile":15445.55,"90th_percentile":15445.55},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":19720.23,"10th_percentile":19720.23,"90th_percentile":19720.23,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Mcc","code_information":[{"code":"058","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9800.37,"maximum":52951.76,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":43199.07},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":43199.07},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34684.05},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33743.82},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13067.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13067.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9800.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52951.76},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33361.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13795.09,"10th_percentile":13795.09,"90th_percentile":13795.09,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","code_information":[{"code":"041","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12548.11,"maximum":68104.73,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":55561.15},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":55561.15},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":44609.42},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43400.14},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16730.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16730.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12548.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68104.73},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42908.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":58765.04,"10th_percentile":58765.04,"90th_percentile":58765.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":59008.62,"10th_percentile":59008.62,"90th_percentile":59008.62,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17186.47,"10th_percentile":17186.47,"90th_percentile":17186.47,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer Without Mcc","code_information":[{"code":"384","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4999.68,"maximum":26477.43,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21600.8},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21600.8},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17343.04},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16872.9},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6666.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6666.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4999.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26477.43},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16681.93}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4577.3,"maximum":24148.11,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19700.49},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19700.49},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15817.3},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15388.52},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6103.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6103.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4577.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24148.11},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15214.36}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":19718.18,"10th_percentile":10835.63,"90th_percentile":21435.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":15831.51,"10th_percentile":15831.51,"90th_percentile":15831.51,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8860.67,"10th_percentile":8860.67,"90th_percentile":8860.67,"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":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5043.79,"10th_percentile":4845.48,"90th_percentile":5858.14,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5887.92,"10th_percentile":5706.48,"90th_percentile":5980.07,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6003.36,"10th_percentile":6003.36,"90th_percentile":6304.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5914.46,"10th_percentile":5914.46,"90th_percentile":5914.46,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4845.48,"10th_percentile":4845.48,"90th_percentile":4845.48,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":12900.98,"10th_percentile":12900.98,"90th_percentile":12900.98},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":22175.28,"10th_percentile":22175.28,"90th_percentile":22175.28,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Mcc","code_information":[{"code":"405","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30925.18,"maximum":169448.74,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":138239.54},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":138239.54},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":110990.97},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":107982.2},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41233.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41233.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30925.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":169448.74},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":106760.09}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39874.08,"10th_percentile":39874.08,"90th_percentile":39874.08,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":25969.51,"10th_percentile":25969.51,"90th_percentile":25969.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":30941.35,"10th_percentile":30941.35,"90th_percentile":30941.35},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","code_information":[{"code":"255","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15349.21,"maximum":83551.97,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":68163.3},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":68163.3},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":54727.55},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53243.98},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20465.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20465.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15349.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83551.97},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52641.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":18914.69,"10th_percentile":18914.69,"90th_percentile":18914.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Cc","code_information":[{"code":"243","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12167.29,"maximum":66004.63,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":53847.84},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":53847.84},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":43233.83},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42061.84},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16223.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16223.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12167.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66004.63},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41585.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":44414.05,"10th_percentile":44414.05,"90th_percentile":44414.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":16062.72,"10th_percentile":16062.72,"90th_percentile":16062.72,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16592.3,"10th_percentile":14931.96,"90th_percentile":16805.61,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15896.07,"10th_percentile":15896.07,"90th_percentile":15896.07,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","code_information":[{"code":"233","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43140.05,"maximum":236810.07,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":193194.2},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":193194.2},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":155113.46},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":150908.6},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57520.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57520.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43140.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":236810.07},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":149200.67}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":166580.09,"10th_percentile":166580.09,"90th_percentile":217222.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":158586.94,"10th_percentile":158586.94,"90th_percentile":158586.94,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":42045.41,"10th_percentile":42045.41,"90th_percentile":42045.41,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":55621.65,"10th_percentile":50825.57,"90th_percentile":57373.42,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":57231.0,"10th_percentile":57231.0,"90th_percentile":57231.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":57368.26,"10th_percentile":57368.26,"90th_percentile":57368.26,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":245983.07,"10th_percentile":245983.07,"90th_percentile":245983.07},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":155333.2,"10th_percentile":155333.2,"90th_percentile":155333.2},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","code_information":[{"code":"218","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37130.62,"maximum":203669.92,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":166157.83},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":166157.83},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":133406.26},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":129789.85},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49507.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49507.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37130.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":203669.92},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":128320.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support >96 Hours","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36340.9,"maximum":199314.83,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":162604.87},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":162604.87},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":130553.63},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":127014.54},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48454.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48454.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36340.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":199314.83},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":125577.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":242234.14,"10th_percentile":242234.14,"90th_percentile":242234.14,"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":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":208090.48,"10th_percentile":208090.48,"90th_percentile":208090.48,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":46180.36,"10th_percentile":46180.36,"90th_percentile":46180.36,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":346797.15,"10th_percentile":346797.15,"90th_percentile":346797.15,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Mcc","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10107.04,"maximum":54643.0,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":44578.81},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":44578.81},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":35791.82},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34821.57},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13476.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13476.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10107.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54643.0},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34427.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12765.43,"10th_percentile":12765.43,"90th_percentile":12765.43,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":10214.85,"10th_percentile":10214.85,"90th_percentile":10214.85,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9260.92,"10th_percentile":9260.92,"90th_percentile":9260.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4250.22,"10th_percentile":4250.22,"90th_percentile":4250.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":21687.91,"10th_percentile":21687.91,"90th_percentile":21687.91,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4933.4,"maximum":26111.93,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21302.61},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21302.61},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17103.63},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16639.98},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6577.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6577.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4933.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26111.93},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16451.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":17430.28,"10th_percentile":17430.28,"90th_percentile":17430.28,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6481.42,"10th_percentile":6481.42,"90th_percentile":6481.42,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6457.55,"10th_percentile":6457.55,"90th_percentile":6457.55,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","code_information":[{"code":"372","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5933.2,"maximum":31625.48,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25800.67},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25800.67},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20715.07},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20153.52},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7910.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7910.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5933.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31625.48},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19925.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":30104.89,"10th_percentile":30104.89,"90th_percentile":30104.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":20883.47,"10th_percentile":20883.47,"90th_percentile":20883.47,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7156.98,"10th_percentile":6145.85,"90th_percentile":7767.99,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5737.12,"10th_percentile":5737.12,"90th_percentile":5737.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":63086.22,"10th_percentile":63086.22,"90th_percentile":63086.22},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"1 through 10","median_amount":4200.0,"10th_percentile":4200.0,"90th_percentile":4200.0},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":23992.87,"10th_percentile":23992.87,"90th_percentile":23992.87},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Cc","code_information":[{"code":"357","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13260.32,"maximum":72032.36,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":58765.39},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":58765.39},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":47182.07},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45903.04},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17680.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17680.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13260.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72032.36},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45383.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures Without Cc/Mcc","code_information":[{"code":"349","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5088.43,"maximum":26966.84,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22000.06},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22000.06},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17663.6},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17184.77},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6784.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6784.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5088.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26966.84},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16990.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Mcc","code_information":[{"code":"335","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20255.49,"maximum":110608.63,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":90236.64},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":90236.64},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":72449.99},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70486.0},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27007.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27007.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20255.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110608.63},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69688.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26928.33,"10th_percentile":26928.33,"90th_percentile":26928.33,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Cc","code_information":[{"code":"327","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13927.04,"maximum":75709.1,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":61764.93},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":61764.93},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":49590.37},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48246.06},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18569.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18569.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13927.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75709.1},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47700.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":40400.52,"10th_percentile":40400.52,"90th_percentile":40400.52,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":11424.27,"10th_percentile":11424.27,"90th_percentile":11424.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15880.85,"10th_percentile":15880.85,"90th_percentile":15880.85,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16284.18,"10th_percentile":16284.18,"90th_percentile":16284.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures With Mcc","code_information":[{"code":"319","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25265.68,"maximum":138238.33,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":112777.48},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":112777.48},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":90547.78},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":88093.18},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33687.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33687.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25265.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":138238.33},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":87096.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Angina Pectoris","code_information":[{"code":"311","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4140.87,"maximum":21741.35,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17737.01},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17737.01},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14240.85},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13854.8},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5521.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5521.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4140.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21741.35},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13698.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis Without Mcc","code_information":[{"code":"303","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3979.67,"maximum":20852.37,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17011.76},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17011.76},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13658.55},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13288.29},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5306.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5306.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3979.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20852.37},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13137.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3827.3,"10th_percentile":3827.3,"90th_percentile":3827.3,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8522.14,"10th_percentile":8522.14,"90th_percentile":8522.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock Without Cc/Mcc","code_information":[{"code":"293","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3377.55,"maximum":17531.85,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":14302.82},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":14302.82},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11483.57},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11172.27},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4503.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4503.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3377.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17531.85},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11045.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired Without Cc/Mcc","code_information":[{"code":"285","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3562.34,"maximum":18550.93,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15134.2},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15134.2},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12151.08},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11821.69},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4749.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4749.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3562.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18550.93},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11687.89}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Mcc","code_information":[{"code":"277","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26139.66,"maximum":143058.04,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":116709.5},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":116709.5},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":93704.75},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":91164.57},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34852.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34852.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26139.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":143058.04},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":90132.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":127404.51,"10th_percentile":127404.51,"90th_percentile":127404.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33252.9,"10th_percentile":32608.32,"90th_percentile":34198.35,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32569.25,"10th_percentile":32569.25,"90th_percentile":32569.25,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":173642.82,"10th_percentile":173642.82,"90th_percentile":173642.82},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","code_information":[{"code":"269","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23919.34,"maximum":130813.62,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":106720.26},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":106720.26},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":85684.5},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":83361.74},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31892.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31892.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23919.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":130813.62},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82418.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30607.5,"10th_percentile":30607.5,"90th_percentile":30624.31,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29017.97,"10th_percentile":29017.97,"90th_percentile":29017.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":128868.39,"10th_percentile":128868.39,"90th_percentile":128868.39,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Cc","code_information":[{"code":"261","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10817.01,"maximum":58558.24,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":47772.94},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":47772.94},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":38356.35},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37316.58},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14422.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14422.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10817.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58558.24},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36894.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Mcc","code_information":[{"code":"183","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8791.59,"maximum":47388.65,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":38660.57},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":38660.57},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31040.14},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30198.7},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11722.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11722.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8791.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47388.65},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29856.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":19758.28,"10th_percentile":19758.28,"90th_percentile":19758.28,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":17852.37,"10th_percentile":17852.37,"90th_percentile":17852.37,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11893.43,"10th_percentile":11893.43,"90th_percentile":11893.43,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":11779.81,"10th_percentile":11779.81,"90th_percentile":11779.81,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":49993.74,"10th_percentile":49993.74,"90th_percentile":49993.74,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7913.68,"maximum":42547.26,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":34710.87},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":34710.87},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":27868.97},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27113.49},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10551.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10551.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7913.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42547.26},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26806.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":15652.23,"10th_percentile":15652.23,"90th_percentile":15652.23,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9188.14,"10th_percentile":9188.14,"90th_percentile":9188.14,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10497.54,"10th_percentile":10485.72,"90th_percentile":10853.22,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9188.14,"10th_percentile":9188.14,"90th_percentile":9188.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"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":9666.15,"10th_percentile":9666.15,"90th_percentile":9666.15,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10338.93,"10th_percentile":10338.93,"90th_percentile":10338.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":11137.01,"10th_percentile":11137.01,"90th_percentile":11137.01},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":41568.45,"10th_percentile":41568.45,"90th_percentile":41568.45,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases Without Cc/Mcc","code_information":[{"code":"159","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4177.94,"maximum":21945.79,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17903.8},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17903.8},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14374.76},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13985.08},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5570.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5570.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4177.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21945.79},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13826.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis Without Mcc","code_information":[{"code":"151","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4321.17,"maximum":22735.65,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18548.18},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18548.18},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14892.13},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14488.43},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5761.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5761.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4321.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22735.65},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14324.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":4652.89,"10th_percentile":4652.89,"90th_percentile":4652.89,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","code_information":[{"code":"143","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21242.36,"maximum":116050.94,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":94676.58},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":94676.58},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":76014.77},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":73954.14},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28323.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28323.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21242.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116050.94},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":73117.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures With Cc/Mcc","code_information":[{"code":"135","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12386.91,"maximum":67215.75,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":54835.9},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":54835.9},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":44027.13},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42833.63},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16515.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16515.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12386.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67215.75},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42348.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extraocular Procedures Except Orbit","code_information":[{"code":"115","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8819.67,"maximum":47543.53,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":38786.92},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":38786.92},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31141.59},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30297.39},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11759.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11759.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8819.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47543.53},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29954.49}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction Without Mcc","code_information":[{"code":"068","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5053.6,"maximum":26774.79,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21843.39},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21843.39},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17537.81},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17062.39},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6738.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6738.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5053.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26774.79},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16869.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":15488.99,"10th_percentile":15488.99,"90th_percentile":15488.99,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6878.46,"10th_percentile":6878.46,"90th_percentile":6878.46,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","code_information":[{"code":"060","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5364.77,"maximum":28490.81,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23243.35},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23243.35},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18661.82},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18155.93},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7153.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7153.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5364.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28490.81},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17950.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7568.01,"10th_percentile":7568.01,"90th_percentile":7568.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7493.08,"10th_percentile":7493.08,"90th_percentile":7493.08,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":16132.23,"10th_percentile":16132.23,"90th_percentile":16132.23},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":13488.82,"10th_percentile":13488.82,"90th_percentile":13488.82,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries With Cc/Mcc","code_information":[{"code":"052","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10372.16,"maximum":56105.02,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":45771.55},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":45771.55},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36749.47},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35753.25},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13829.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13829.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10372.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56105.02},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35348.61}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer Without Cc/Mcc","code_information":[{"code":"382","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4695.25,"maximum":24798.59,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20231.16},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20231.16},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16243.37},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15803.04},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6260.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6260.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4695.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24798.59},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15624.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5164.03,"10th_percentile":5164.03,"90th_percentile":5164.03,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction Without Cc/Mcc","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3253.98,"maximum":16850.4,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":13746.88},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":13746.88},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":11037.22},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10738.02},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4338.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4338.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3253.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16850.4},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10616.49}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":12678.95,"10th_percentile":11700.95,"90th_percentile":14140.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":11102.14,"10th_percentile":11102.14,"90th_percentile":11102.14,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":3778.94,"10th_percentile":3778.94,"90th_percentile":3964.57,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":14949.07,"10th_percentile":14949.07,"90th_percentile":14949.07},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":12746.18,"10th_percentile":12746.18,"90th_percentile":12746.18,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures Without Cc/Mcc","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6628.0,"maximum":35457.08,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28926.57},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28926.57},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23224.82},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22595.23},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8837.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8837.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6628.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35457.08},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22339.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":29993.43,"10th_percentile":29993.43,"90th_percentile":29993.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":16537.71,"10th_percentile":16537.71,"90th_percentile":16537.71,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"1 through 10","median_amount":47988.17,"10th_percentile":47988.17,"90th_percentile":47988.17,"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":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9537.28,"10th_percentile":9537.28,"90th_percentile":9995.14,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":31338.32,"10th_percentile":31338.32,"90th_percentile":31338.32,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Mcc","code_information":[{"code":"411","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18752.44,"maximum":102319.72,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":83474.39},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":83474.39},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":67020.65},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65203.84},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25003.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25003.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18752.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":102319.72},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64465.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Generator Procedures","code_information":[{"code":"245","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25824.56,"maximum":141320.34,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":115291.85},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":115291.85},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":92566.53},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":90057.21},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34432.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34432.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25824.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":141320.34},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":89037.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization With Mcc","code_information":[{"code":"235","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33161.23,"maximum":181779.89,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":148299.52},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":148299.52},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":119068.03},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":115840.3},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44214.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44214.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33161.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":181779.89},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":114529.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":148693.73,"10th_percentile":148693.73,"90th_percentile":148693.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":119384.53,"10th_percentile":119384.53,"90th_percentile":119384.53,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":35342.47,"10th_percentile":35342.47,"90th_percentile":35342.47,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43271.21,"10th_percentile":43247.41,"90th_percentile":87798.57,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":155204.66,"10th_percentile":155204.66,"90th_percentile":155204.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","code_information":[{"code":"220","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30151.75,"maximum":165183.48,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":134759.86},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":134759.86},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":108197.18},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":105264.14},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40202.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40202.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30151.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":165183.48},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":104072.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":133847.61,"10th_percentile":133847.61,"90th_percentile":139730.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":107464.75,"10th_percentile":107464.75,"90th_percentile":107464.75,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":32235.77,"10th_percentile":32235.77,"90th_percentile":42930.8,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38950.68,"10th_percentile":36860.33,"90th_percentile":48897.37,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":42930.8,"10th_percentile":42930.8,"90th_percentile":42930.8,"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":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":177651.21,"10th_percentile":177651.21,"90th_percentile":177651.21},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex Aortic Arch Procedures","code_information":[{"code":"209","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":63773.96,"maximum":350599.83,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":286026.08},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":286026.08},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":229647.13},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":223421.79},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85031.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85031.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63773.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":350599.83},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":220893.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax Without Cc/Mcc","code_information":[{"code":"201","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4215.02,"maximum":22150.22,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18070.58},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18070.58},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14508.66},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14115.36},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5620.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5620.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4215.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22150.22},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13955.61}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":17110.32,"10th_percentile":17110.32,"90th_percentile":17110.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":13197.93,"10th_percentile":13197.93,"90th_percentile":13197.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5338.61,"10th_percentile":5338.61,"90th_percentile":5338.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5163.76,"10th_percentile":5163.76,"90th_percentile":5163.76,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":30165.39,"10th_percentile":30165.39,"90th_percentile":30165.39,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7581.16,"maximum":40713.54,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33214.89},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33214.89},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26667.86},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25944.94},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10108.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10108.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7581.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40713.54},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25651.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":30511.73,"10th_percentile":30511.73,"90th_percentile":33048.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":17826.4,"10th_percentile":15568.43,"90th_percentile":27921.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7306.47,"10th_percentile":6192.31,"90th_percentile":10730.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":9827.41,"10th_percentile":8093.07,"90th_percentile":9931.58,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":8214.03,"10th_percentile":8170.91,"90th_percentile":9878.97,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7306.47,"10th_percentile":6866.29,"90th_percentile":7307.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8170.93,"10th_percentile":8170.93,"90th_percentile":9813.41,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":8373.12,"10th_percentile":8373.12,"90th_percentile":8373.12},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":24006.59,"10th_percentile":24006.59,"90th_percentile":24006.59},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches With Mcc","code_information":[{"code":"102","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6494.32,"maximum":34719.88,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28325.14},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28325.14},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22741.94},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22125.45},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8659.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8659.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6494.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34719.88},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21875.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8130.19,"10th_percentile":8130.19,"90th_percentile":8130.19,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4284.1,"maximum":22531.22,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18381.4},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18381.4},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14758.22},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14358.15},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5712.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5712.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4284.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22531.22},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14195.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":11517.64,"10th_percentile":11517.64,"90th_percentile":11517.64,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5505.49,"10th_percentile":5505.49,"90th_percentile":6606.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":8772.58,"10th_percentile":8772.58,"90th_percentile":8772.58},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":8529.61,"10th_percentile":8529.61,"90th_percentile":8529.61,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"358","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8050.17,"maximum":43299.95,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35324.93},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35324.93},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28361.99},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27593.15},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10733.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10733.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8050.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43299.95},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27280.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10094.07,"10th_percentile":10094.07,"90th_percentile":10094.07,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Mcc","code_information":[{"code":"350","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14194.96,"maximum":77186.6,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":62970.31},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":62970.31},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":50558.16},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49187.61},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18926.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18926.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14194.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77186.6},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48630.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":52935.43,"10th_percentile":52935.43,"90th_percentile":52935.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":49073.0,"10th_percentile":49073.0,"90th_percentile":49073.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Cc","code_information":[{"code":"336","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12042.6,"maximum":65316.98,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":53286.85},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":53286.85},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":42783.41},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41623.63},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16056.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16056.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12042.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65316.98},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41152.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":47074.42,"10th_percentile":47074.42,"90th_percentile":47074.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15633.42,"10th_percentile":15633.42,"90th_percentile":15754.17,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","code_information":[{"code":"328","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9198.25,"maximum":49631.24,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":40490.12},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":40490.12},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":32509.06},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31627.8},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12264.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12264.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9198.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49631.24},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31269.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":58848.24,"10th_percentile":58848.24,"90th_percentile":58848.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":11966.0,"10th_percentile":11966.0,"90th_percentile":11966.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12024.15,"10th_percentile":12024.15,"90th_percentile":12024.15,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures Without Mcc","code_information":[{"code":"320","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13708.54,"maximum":74504.17,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":60781.93},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":60781.93},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":48801.13},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47478.22},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18278.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18278.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13708.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74504.17},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46940.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Syncope And Collapse","code_information":[{"code":"312","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5094.04,"maximum":26997.81,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22025.33},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22025.33},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17683.89},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17204.51},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6792.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6792.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5094.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26997.81},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17009.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7247.92,"10th_percentile":7247.92,"90th_percentile":7247.92,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6553.82,"10th_percentile":6547.4,"90th_percentile":6662.19,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5992.12,"10th_percentile":5992.12,"90th_percentile":6572.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":3854.62,"10th_percentile":3854.62,"90th_percentile":3854.62},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":13898.3,"10th_percentile":13898.3,"90th_percentile":13898.3,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension With Mcc","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6882.44,"maximum":36860.25,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30071.3},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30071.3},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24143.91},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23489.41},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9176.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9176.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6882.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36860.25},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23223.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":13584.67,"10th_percentile":13584.67,"90th_percentile":13584.67,"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":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5270.22,"10th_percentile":5270.22,"90th_percentile":5270.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":14803.66,"10th_percentile":14803.66,"90th_percentile":14803.66},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Mcc","code_information":[{"code":"296","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8971.33,"maximum":48379.85,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":39469.21},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39469.21},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31689.39},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30830.34},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11961.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11961.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8971.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48379.85},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30481.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":23259.85,"10th_percentile":23259.85,"90th_percentile":23259.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":15685.73,"10th_percentile":15685.73,"90th_percentile":15685.73,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12193.69,"10th_percentile":12193.69,"90th_percentile":12193.69,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","code_information":[{"code":"286","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12627.31,"maximum":68541.48,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":55917.46},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":55917.46},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":44895.5},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43678.46},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16836.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16836.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12627.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68541.48},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43184.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":38645.95,"10th_percentile":36247.37,"90th_percentile":82378.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":44219.96,"10th_percentile":42891.45,"90th_percentile":44905.64,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9974.38,"10th_percentile":9974.38,"90th_percentile":9974.38,"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":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":14232.2,"10th_percentile":14232.2,"90th_percentile":14232.2,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":16381.03,"10th_percentile":15964.41,"90th_percentile":16518.07,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9974.38,"10th_percentile":9974.38,"90th_percentile":9974.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"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":16358.09,"10th_percentile":16358.09,"90th_percentile":16358.09,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14767.69,"10th_percentile":14767.69,"90th_percentile":14767.69,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":59311.15,"10th_percentile":59311.15,"90th_percentile":59311.15},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","code_information":[{"code":"278","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31462.71,"maximum":172413.05,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":140657.87},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":140657.87},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":112932.63},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":109871.22},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41950.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41950.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31462.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":172413.05},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":108627.73}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35456.51,"10th_percentile":35456.51,"90th_percentile":35456.51,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Mcc","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29834.39,"maximum":163433.39,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":133332.1},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":133332.1},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":107050.85},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":104148.89},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39779.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39779.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29834.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":163433.39},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":102970.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":124955.84,"10th_percentile":124955.84,"90th_percentile":124955.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":48485.22,"10th_percentile":48485.22,"90th_percentile":48485.22,"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":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":31131.76,"10th_percentile":31131.76,"90th_percentile":31131.76,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37757.81,"10th_percentile":35970.17,"90th_percentile":38977.37,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":31131.76,"10th_percentile":31131.76,"90th_percentile":31131.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":320256.16,"10th_percentile":320256.16,"90th_percentile":320256.16,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","code_information":[{"code":"262","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9353.27,"maximum":50486.15,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":41187.57},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":41187.57},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33069.04},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32172.6},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12471.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12471.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9353.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50486.15},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31808.48}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Cc","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6175.28,"maximum":32960.5,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26889.81},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26889.81},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21589.52},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21004.27},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8233.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8233.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6175.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32960.5},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20766.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":21327.85,"10th_percentile":21327.85,"90th_percentile":21327.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":26990.89,"10th_percentile":26990.89,"90th_percentile":26990.89,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8021.92,"10th_percentile":7624.58,"90th_percentile":8074.77,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"1 through 10","median_amount":25644.42,"10th_percentile":25644.42,"90th_percentile":25644.42,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism Without Mcc","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4719.97,"maximum":24934.88,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20342.35},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20342.35},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16332.65},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15889.9},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6293.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6293.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4719.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24934.88},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15710.06}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":10880.3,"10th_percentile":10880.3,"90th_percentile":10880.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6152.17,"10th_percentile":6141.9,"90th_percentile":6224.61,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6182.61,"10th_percentile":6182.61,"90th_percentile":6182.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Mcc","code_information":[{"code":"163","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25371.84,"maximum":138823.76,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":113255.09},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":113255.09},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":90931.24},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":88466.25},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33829.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33829.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25371.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":138823.76},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":87465.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":95206.88,"10th_percentile":95206.88,"90th_percentile":95206.88,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":29210.38,"10th_percentile":29210.38,"90th_percentile":29210.38,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri With Mcc","code_information":[{"code":"152","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6838.63,"maximum":36618.65,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":29874.19},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29874.19},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23985.66},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23335.45},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9118.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9118.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6838.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36618.65},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23071.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","code_information":[{"code":"144","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9931.8,"maximum":53676.58,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":43790.38},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":43790.38},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":35158.81},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34205.71},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13242.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13242.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9931.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53676.58},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33818.58}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures Without Cc/Mcc","code_information":[{"code":"136","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5901.18,"maximum":31448.92,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25656.63},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25656.63},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20599.42},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20041.01},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7868.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7868.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5901.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31448.92},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19814.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures With Cc/Mcc","code_information":[{"code":"116","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10354.18,"maximum":56005.9,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":45690.69},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":45690.69},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36684.54},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35690.09},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13805.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13805.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10354.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56005.9},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35286.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient Ischemia Without Thrombolytic","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4685.14,"maximum":24742.83,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20185.68},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20185.68},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16206.85},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15767.51},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6246.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6246.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4685.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24742.83},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15589.06}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":15530.09,"10th_percentile":15530.09,"90th_percentile":15530.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6524.14,"10th_percentile":6524.14,"90th_percentile":6524.14,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6067.79,"10th_percentile":6067.79,"90th_percentile":6083.32,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":11744.03,"10th_percentile":11744.03,"90th_percentile":11744.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","code_information":[{"code":"061","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15684.53,"maximum":85401.17,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":69671.92},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":69671.92},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":55938.8},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54422.4},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20912.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20912.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15684.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85401.17},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53806.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":68091.3,"10th_percentile":68091.3,"90th_percentile":68091.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries Without Cc/Mcc","code_information":[{"code":"053","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5698.41,"maximum":30330.72,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24744.38},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24744.38},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19866.99},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19328.43},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7597.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7597.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5698.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30330.72},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19109.68}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Cc","code_information":[{"code":"381","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6284.24,"maximum":33561.41,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27380.05},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27380.05},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21983.13},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21387.21},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8378.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8378.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6284.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33561.41},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21145.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6539.15,"10th_percentile":6539.15,"90th_percentile":6539.15,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Cc","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4634.59,"maximum":24464.06,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19958.25},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19958.25},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16024.25},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15589.86},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6179.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6179.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4634.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24464.06},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15413.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":30491.01,"10th_percentile":30491.01,"90th_percentile":30491.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4903.06,"10th_percentile":4903.06,"90th_percentile":4903.06,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6054.93,"10th_percentile":6033.56,"90th_percentile":6225.66,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4967.28,"10th_percentile":4967.28,"90th_percentile":4967.28,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4967.28,"10th_percentile":4967.28,"90th_percentile":4967.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6036.78,"10th_percentile":6036.78,"90th_percentile":6036.78,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5216.58,"10th_percentile":5216.58,"90th_percentile":5216.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":23791.28,"10th_percentile":23791.28,"90th_percentile":23791.28,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Cc","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8700.04,"maximum":46883.76,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":38248.67},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":38248.67},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30709.43},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29876.95},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11600.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11600.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8700.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46883.76},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29538.81}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":37632.01,"10th_percentile":37632.01,"90th_percentile":37632.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":12167.84,"10th_percentile":12167.84,"90th_percentile":12167.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":27990.67,"10th_percentile":27990.67,"90th_percentile":27990.67,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","code_information":[{"code":"410","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9116.24,"maximum":49179.01,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":40121.18},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":40121.18},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":32212.85},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31339.61},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12154.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12154.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9116.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49179.01},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30984.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","code_information":[{"code":"250","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12457.12,"maximum":67602.94,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":55151.78},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":55151.78},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":44280.74},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43080.37},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16609.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16609.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12457.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67602.94},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42592.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17076.58,"10th_percentile":17076.58,"90th_percentile":17076.58,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization Without Mcc","code_information":[{"code":"236","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23726.12,"maximum":129748.08,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":105850.98},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":105850.98},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":84986.56},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82682.72},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31634.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31634.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23726.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":129748.08},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":81746.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":103912.77,"10th_percentile":103912.77,"90th_percentile":108354.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":83430.4,"10th_percentile":83424.31,"90th_percentile":151847.39,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30289.67,"10th_percentile":29419.67,"90th_percentile":32777.44,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":42045.41,"10th_percentile":42045.41,"90th_percentile":42045.41,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":29467.65,"10th_percentile":29467.65,"90th_percentile":29467.65,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":127363.01,"10th_percentile":127363.01,"90th_percentile":127363.01,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","code_information":[{"code":"221","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28508.26,"maximum":156120.2,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":127365.85},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":127365.85},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":102260.62},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":99488.51},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38011.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38011.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28508.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":156120.2},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":98362.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Aortic And Mitral Valve Procedures","code_information":[{"code":"212","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":61276.16,"maximum":336825.25,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":274788.51},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":274788.51},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":220624.61},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":214643.86},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81701.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81701.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61276.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":336825.25},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":212214.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":189134.14,"10th_percentile":189134.14,"90th_percentile":189134.14,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":46008.07,"10th_percentile":46008.07,"90th_percentile":46008.07,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma With Cc/Mcc","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5653.48,"maximum":30082.92,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24542.22},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24542.22},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19704.68},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19170.52},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7537.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7537.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5653.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30082.92},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18953.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":21719.3,"10th_percentile":21719.3,"90th_percentile":21719.3,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"12","median_amount":5950.27,"10th_percentile":4014.35,"90th_percentile":7402.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6551.79,"10th_percentile":6551.79,"90th_percentile":6551.79,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":5602.44,"10th_percentile":5602.44,"90th_percentile":5602.44,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6278.21,"10th_percentile":6278.21,"90th_percentile":6278.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6294.0,"10th_percentile":6294.0,"90th_percentile":6294.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":5685.56,"10th_percentile":5685.56,"90th_percentile":5685.56},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Cc","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4725.02,"maximum":24962.75,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20365.09},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20365.09},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16350.91},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15907.66},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6300.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6300.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4725.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24962.75},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15727.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7306.47,"10th_percentile":7306.47,"90th_percentile":7306.47,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6182.12,"10th_percentile":5487.07,"90th_percentile":6296.41,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4858.75,"10th_percentile":4858.75,"90th_percentile":4858.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4856.68,"10th_percentile":4856.68,"90th_percentile":4856.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":34296.7,"10th_percentile":34296.7,"90th_percentile":34296.7},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches Without Mcc","code_information":[{"code":"103","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4895.77,"maximum":25904.39,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21133.3},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21133.3},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16967.69},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16507.73},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6527.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6527.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4895.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25904.39},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16320.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":17249.71,"10th_percentile":17249.71,"90th_percentile":17249.71,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7218.25,"10th_percentile":5278.81,"90th_percentile":9669.87,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6446.12,"10th_percentile":6446.12,"90th_percentile":6446.12,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":6425.94,"10th_percentile":6425.94,"90th_percentile":6425.94,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6396.15,"10th_percentile":6396.15,"90th_percentile":6396.15,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":6991.03,"10th_percentile":6991.03,"90th_percentile":6991.03},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":24825.87,"10th_percentile":24825.87,"90th_percentile":24825.87,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures With Mcc","code_information":[{"code":"100","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11077.06,"maximum":59992.38,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":48942.94},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":48942.94},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":39295.74},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38230.5},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14769.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14769.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11077.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59992.38},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37797.81}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":50748.03,"10th_percentile":50748.03,"90th_percentile":50748.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":40279.75,"10th_percentile":40279.75,"90th_percentile":40279.75,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7503.27,"10th_percentile":7503.27,"90th_percentile":7503.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":14698.62,"10th_percentile":13378.06,"90th_percentile":14724.02,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14690.62,"10th_percentile":14690.62,"90th_percentile":14690.62,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Cc","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5944.43,"maximum":31687.43,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25851.21},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25851.21},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20755.65},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20193.0},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7925.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7925.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5944.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31687.43},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19964.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":21474.42,"10th_percentile":21474.42,"90th_percentile":21474.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":26506.52,"10th_percentile":26506.52,"90th_percentile":26506.52,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7924.73,"10th_percentile":7924.73,"90th_percentile":7984.97,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":7918.12,"10th_percentile":7918.12,"90th_percentile":7918.12,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8244.02,"10th_percentile":8244.02,"90th_percentile":8244.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7218.25,"10th_percentile":7218.25,"90th_percentile":7218.25,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":33104.74,"10th_percentile":33104.74,"90th_percentile":33104.74,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","code_information":[{"code":"084","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5566.98,"maximum":29605.91,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24153.07},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24153.07},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19392.23},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18866.54},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7422.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7422.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5566.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29605.91},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18653.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":10903.15,"10th_percentile":10903.15,"90th_percentile":10903.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8429.14,"10th_percentile":8429.14,"90th_percentile":8429.14,"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":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Mcc","code_information":[{"code":"037","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18689.53,"maximum":101972.8,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":83191.37},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":83191.37},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":66793.42},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64982.76},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24919.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24919.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18689.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101972.8},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64247.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":67377.74,"10th_percentile":67377.74,"90th_percentile":67377.74,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22413.99,"10th_percentile":22413.99,"90th_percentile":22413.99,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":22872.63,"10th_percentile":22872.63,"90th_percentile":22872.63,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Cc Or Spinal Neurostimulators","code_information":[{"code":"029","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19360.73,"maximum":105674.31,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":86211.13},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":86211.13},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":69217.95},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67341.57},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25814.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25814.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19360.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":105674.31},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":66579.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":14449.77,"10th_percentile":14449.77,"90th_percentile":14449.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","code_information":[{"code":"021","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29932.69,"maximum":163975.46,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":133774.33},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":133774.33},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":107405.91},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":104494.32},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39910.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39910.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29932.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":163975.46},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":103311.68}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","code_information":[{"code":"012","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23878.9,"maximum":130590.6,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":106538.32},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":106538.32},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":85538.42},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":83219.62},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31838.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31838.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23878.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":130590.6},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82277.77}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30459.29,"10th_percentile":30459.29,"90th_percentile":30459.29,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","code_information":[{"code":"003","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":119416.29,"maximum":657450.57,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":536360.8},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":536360.8},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":430638.08},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":418964.22},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":159221.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":159221.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119416.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":657450.57},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":414222.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":541576.53,"10th_percentile":541576.53,"90th_percentile":541576.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":434825.73,"10th_percentile":434825.73,"90th_percentile":434825.73,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":141281.1,"10th_percentile":141281.1,"90th_percentile":141281.1,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":443296.12,"10th_percentile":443296.12,"90th_percentile":443296.12},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":171940.13,"10th_percentile":171940.13,"90th_percentile":171940.13,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","code_information":[{"code":"417","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13602.38,"maximum":73918.74,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":60304.33},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":60304.33},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":48417.67},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47105.15},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18136.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18136.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13602.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73918.74},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46572.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":60304.33,"10th_percentile":60304.33,"90th_percentile":60304.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":48216.81,"10th_percentile":48216.81,"90th_percentile":48216.81,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":11159.59,"10th_percentile":11159.59,"90th_percentile":11159.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17674.25,"10th_percentile":17674.25,"90th_percentile":17732.3,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":3403.21,"10th_percentile":3403.21,"90th_percentile":3403.21},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":63425.21,"10th_percentile":63425.21,"90th_percentile":63425.21},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":73612.09,"10th_percentile":73612.09,"90th_percentile":171112.09,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":25606.31,"10th_percentile":25606.31,"90th_percentile":25606.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","code_information":[{"code":"425","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8625.33,"maximum":46471.79,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":37912.58},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37912.58},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30439.59},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29614.42},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11500.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11500.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8625.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46471.79},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29279.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"434","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4200.41,"maximum":22069.69,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18004.88},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18004.88},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14455.91},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14064.04},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5600.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5600.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4200.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22069.69},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13904.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5549.63,"10th_percentile":5549.63,"90th_percentile":5549.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":12487.28,"10th_percentile":12487.28,"90th_percentile":12487.28,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","code_information":[{"code":"442","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5620.34,"maximum":29900.17,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24393.13},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24393.13},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19584.97},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19054.06},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7493.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7493.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5620.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29900.17},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18838.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5684.81,"10th_percentile":5684.81,"90th_percentile":9023.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7255.14,"10th_percentile":7241.27,"90th_percentile":7401.63,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":9617.02,"10th_percentile":9617.02,"90th_percentile":9617.02},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":15313.34,"10th_percentile":15313.34,"90th_percentile":15313.34,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"451","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18342.97,"maximum":100061.64,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":81632.21},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":81632.21},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":65541.59},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63764.87},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24457.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24457.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18342.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100061.64},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63043.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":62611.85,"10th_percentile":62611.85,"90th_percentile":82399.85,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":21228.44,"10th_percentile":21228.44,"90th_percentile":21228.44,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23328.31,"10th_percentile":23328.31,"90th_percentile":23971.31,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement Or Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With","code_information":[{"code":"465","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10441.81,"maximum":56489.11,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":46084.9},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":46084.9},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":37001.05},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35998.01},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13922.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13922.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10441.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56489.11},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35590.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":122679.25,"10th_percentile":122679.25,"90th_percentile":122679.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":13373.08,"10th_percentile":13373.08,"90th_percentile":13373.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion Without Cc/Mcc","code_information":[{"code":"473","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13910.74,"maximum":75619.27,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":61691.65},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":61691.65},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":49531.54},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48188.82},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18547.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18547.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13910.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75619.27},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47643.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Cc","code_information":[{"code":"481","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11962.84,"maximum":64877.14,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":52928.02},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":52928.02},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":42495.31},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41343.34},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15950.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15950.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11962.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64877.14},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40875.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":44493.46,"10th_percentile":44493.46,"90th_percentile":47786.08,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":12696.94,"10th_percentile":12696.94,"90th_percentile":12696.94,"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":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":12571.23,"10th_percentile":12571.23,"90th_percentile":12571.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"18","median_amount":15372.44,"10th_percentile":13770.28,"90th_percentile":16754.27,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13805.17,"10th_percentile":13805.17,"90th_percentile":13805.17,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":17711.05,"10th_percentile":17711.05,"90th_percentile":17711.05,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":64423.68,"10th_percentile":64423.68,"90th_percentile":64423.68,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"1 through 10","median_amount":67634.47,"10th_percentile":67634.47,"90th_percentile":69609.02,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc Or Insertion Of Antibioti","code_information":[{"code":"492","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20821.1,"maximum":113727.81,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":92781.33},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":92781.33},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":74493.09},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":72473.71},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27761.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27761.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20821.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":113727.81},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71653.48}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":21076.97,"10th_percentile":21076.97,"90th_percentile":21076.97,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24588.07,"10th_percentile":24588.07,"90th_percentile":24588.07,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":70702.14,"10th_percentile":70702.14,"90th_percentile":70702.14,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"1 through 10","median_amount":85140.51,"10th_percentile":85140.51,"90th_percentile":85140.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Mcc","code_information":[{"code":"500","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17974.51,"maximum":98029.68,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":79974.5},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":79974.5},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":64210.63},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62469.99},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23966.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23966.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17974.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98029.68},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61762.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23558.31,"10th_percentile":23558.31,"90th_percentile":23558.31,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","code_information":[{"code":"508","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8704.53,"maximum":46908.54,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":38268.89},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":38268.89},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30725.66},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29892.74},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11606.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11606.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8704.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46908.54},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29554.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","code_information":[{"code":"517","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8829.78,"maximum":47599.28,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":38832.41},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":38832.41},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31178.11},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30332.92},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11773.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11773.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8829.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47599.28},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29989.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11216.21,"10th_percentile":11216.21,"90th_percentile":11216.21,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":46233.29,"10th_percentile":46233.29,"90th_percentile":46233.29,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis With Mcc","code_information":[{"code":"535","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7399.18,"maximum":39709.95,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":32396.14},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":32396.14},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26010.5},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25305.4},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9865.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9865.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7399.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39709.95},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25019.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"1 through 10","median_amount":20380.56,"10th_percentile":20380.56,"90th_percentile":20380.56},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"601","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3596.6,"maximum":18739.88,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15288.35},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15288.35},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12274.85},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11942.1},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4795.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4795.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3596.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18739.88},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11806.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4172.45,"10th_percentile":4172.45,"90th_percentile":4172.45,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures Without Cc/Mcc","code_information":[{"code":"615","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8058.03,"maximum":43343.32,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35360.31},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35360.31},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28390.4},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27620.78},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10744.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10744.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8058.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43343.32},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27308.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":43343.32,"10th_percentile":43343.32,"90th_percentile":43343.32,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"623","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10274.42,"maximum":55566.05,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":45331.85},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":45331.85},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36396.44},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35409.79},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13699.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13699.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10274.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55566.05},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35009.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9581.65,"10th_percentile":9581.65,"90th_percentile":9581.65,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14188.98,"10th_percentile":14188.98,"90th_percentile":14188.98,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Mcc","code_information":[{"code":"637","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8268.1,"maximum":44501.78,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":36305.41},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":36305.41},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29149.21},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28359.02},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11024.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11024.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8268.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44501.78},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28038.06}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7210.78,"10th_percentile":7210.78,"90th_percentile":7210.78,"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":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6758.36,"10th_percentile":6758.36,"90th_percentile":7139.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10478.72,"10th_percentile":9890.54,"90th_percentile":10937.54,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":7065.59,"10th_percentile":7065.59,"90th_percentile":7065.59,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10827.61,"10th_percentile":10827.61,"90th_percentile":10827.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":15513.18,"10th_percentile":15513.18,"90th_percentile":15513.18,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":15869.17,"10th_percentile":15869.17,"90th_percentile":15869.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Mcc","code_information":[{"code":"805","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6260.09,"maximum":33428.22,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27271.38},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27271.38},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21895.89},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21302.33},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8346.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8346.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6260.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33428.22},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21061.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":15637.0,"10th_percentile":15637.0,"90th_percentile":15637.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":11286.0,"10th_percentile":11286.0,"90th_percentile":21781.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"16","median_amount":4224.75,"10th_percentile":3065.31,"90th_percentile":4866.56,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3065.31,"10th_percentile":3065.31,"90th_percentile":3065.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":19292.28,"10th_percentile":13012.0,"90th_percentile":23119.63,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":21553.15,"10th_percentile":21553.15,"90th_percentile":21553.15,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coagulation Disorders","code_information":[{"code":"813","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8765.75,"maximum":47246.17,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":38544.33},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":38544.33},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30946.81},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30107.9},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11687.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11687.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8765.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47246.17},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29767.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":58819.96,"10th_percentile":58819.96,"90th_percentile":58819.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":28205.34,"10th_percentile":28205.34,"90th_percentile":28205.34,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":21542.31,"10th_percentile":21542.31,"90th_percentile":21542.31,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11540.63,"10th_percentile":11494.2,"90th_percentile":11603.37,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":10775.7,"10th_percentile":10775.7,"90th_percentile":10775.7,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures With Cc","code_information":[{"code":"821","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12772.22,"maximum":69340.64,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":56569.42},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":56569.42},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":45418.96},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44187.73},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17029.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17029.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12772.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69340.64},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43687.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders Without Cc/Mcc","code_information":[{"code":"645","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4513.83,"maximum":23798.09,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19414.94},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19414.94},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15588.04},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15165.47},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6018.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6018.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4513.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23798.09},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14993.84}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4358.27,"10th_percentile":4358.27,"90th_percentile":4358.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5988.47,"10th_percentile":5988.47,"90th_percentile":6060.9,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Cc","code_information":[{"code":"657","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10477.19,"maximum":56684.25,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":46244.1},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":46244.1},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":37128.87},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36122.37},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13969.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13969.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10477.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56684.25},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35713.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Mcc","code_information":[{"code":"665","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17729.62,"maximum":96679.17,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":78872.72},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":78872.72},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":63326.03},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61609.37},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23639.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23639.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17729.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96679.17},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60912.09}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Mcc","code_information":[{"code":"673","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23798.01,"maximum":130144.56,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":106174.43},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":106174.43},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":85246.26},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82935.38},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31730.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31730.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23798.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":130144.56},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":81996.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30828.81,"10th_percentile":30828.81,"90th_percentile":30828.81,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","code_information":[{"code":"688","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4637.4,"maximum":24479.54,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19970.88},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19970.88},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16034.4},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15599.73},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6183.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6183.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4637.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24479.54},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15423.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":22432.1,"10th_percentile":22432.1,"90th_percentile":22432.1,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Mcc","code_information":[{"code":"698","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9490.88,"maximum":51245.04,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":41806.69},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":41806.69},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33566.12},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32656.2},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12654.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12654.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9490.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51245.04},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32286.61}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":12936.63,"10th_percentile":12936.63,"90th_percentile":12936.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":12471.14,"10th_percentile":9553.3,"90th_percentile":12584.73,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8772.57,"10th_percentile":683.13,"90th_percentile":12461.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":32438.19,"10th_percentile":32438.19,"90th_percentile":32438.19},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage Without Cc/Mcc","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3739.27,"maximum":19526.64,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15930.21},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15930.21},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12790.19},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12443.47},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4985.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4985.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3739.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19526.64},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12302.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4028.07,"10th_percentile":4028.07,"90th_percentile":4028.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4844.1,"10th_percentile":4844.1,"90th_percentile":4844.1,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":19107.36,"10th_percentile":19107.36,"90th_percentile":19107.36},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","code_information":[{"code":"359","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19512.39,"maximum":106510.64,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":86893.42},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":86893.42},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":69765.76},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67874.53},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26016.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26016.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19512.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106510.64},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67106.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":73046.18,"10th_percentile":73046.18,"90th_percentile":73046.18,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Cc","code_information":[{"code":"351","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8761.26,"maximum":47221.39,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":38524.12},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":38524.12},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30930.58},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30092.11},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11681.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11681.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8761.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47221.39},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29751.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9720.65,"10th_percentile":9720.65,"90th_percentile":9720.65,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis Without Cc/Mcc","code_information":[{"code":"337","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8820.23,"maximum":47546.63,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":38789.45},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":38789.45},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31143.62},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30299.37},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11760.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11760.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8820.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47546.63},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29956.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":31154.46,"10th_percentile":31154.46,"90th_percentile":31154.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Mcc","code_information":[{"code":"329","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26016.09,"maximum":142376.59,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":116153.56},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":116153.56},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":93258.39},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":90730.31},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34688.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34688.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26016.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":142376.59},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":89703.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":80105.23,"10th_percentile":80105.23,"90th_percentile":80105.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":93165.06,"10th_percentile":93165.06,"90th_percentile":93165.06,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":24347.34,"10th_percentile":21170.66,"90th_percentile":34701.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":31960.34,"10th_percentile":17670.73,"90th_percentile":33814.67,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":16624.14,"10th_percentile":16624.14,"90th_percentile":16624.14,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":49851.85,"10th_percentile":49851.85,"90th_percentile":49851.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"1 through 10","median_amount":257663.25,"10th_percentile":257663.25,"90th_percentile":257663.25,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","code_information":[{"code":"321","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15480.64,"maximum":84276.78,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":68754.62},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":68754.62},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":55202.31},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53705.87},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20640.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20640.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15480.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84276.78},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53098.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":71938.64,"10th_percentile":71938.64,"90th_percentile":71938.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":57758.73,"10th_percentile":57442.78,"90th_percentile":64354.73,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":19031.61,"10th_percentile":19031.61,"90th_percentile":19031.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":20881.77,"10th_percentile":20404.4,"90th_percentile":30116.06,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"17","median_amount":20995.7,"10th_percentile":20224.82,"90th_percentile":21030.72,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":16008.52,"10th_percentile":16008.52,"90th_percentile":16008.52,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":33945.3,"10th_percentile":33945.3,"90th_percentile":33945.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":16008.52,"10th_percentile":16008.52,"90th_percentile":16008.52,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":50645.93,"10th_percentile":50645.93,"90th_percentile":50645.93},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":79588.46,"10th_percentile":79588.46,"90th_percentile":82113.98,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chest Pain","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4242.54,"maximum":22302.0,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18194.4},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18194.4},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14608.08},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14212.08},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5656.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5656.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4242.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22302.0},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14051.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":7223.85,"10th_percentile":7223.85,"90th_percentile":7223.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":11274.17,"10th_percentile":11274.17,"90th_percentile":11274.17,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5549.73,"10th_percentile":5549.73,"90th_percentile":5549.73,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":22267.44,"10th_percentile":22267.44,"90th_percentile":22267.44,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension Without Mcc","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4439.68,"maximum":23389.22,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19081.38},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19081.38},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15320.22},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14904.92},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5919.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5919.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4439.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23389.22},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14736.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":12229.13,"10th_percentile":12229.13,"90th_percentile":12229.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":15230.95,"10th_percentile":15230.95,"90th_percentile":15230.95,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5054.83,"10th_percentile":5054.83,"90th_percentile":5054.83,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5718.71,"10th_percentile":5718.71,"90th_percentile":5814.28,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5270.22,"10th_percentile":5270.22,"90th_percentile":5270.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Cc","code_information":[{"code":"297","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3759.49,"maximum":19638.15,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16021.18},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16021.18},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12863.23},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12514.53},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5012.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5012.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3759.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19638.15},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12372.89}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","code_information":[{"code":"287","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6208.98,"maximum":33146.35,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27041.43},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27041.43},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21711.26},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21122.7},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8278.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8278.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6208.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33146.35},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20883.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":27536.72,"10th_percentile":27536.72,"90th_percentile":27536.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":22108.92,"10th_percentile":22108.92,"90th_percentile":22108.92,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9974.38,"10th_percentile":9974.38,"90th_percentile":9974.38,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8151.97,"10th_percentile":7768.8,"90th_percentile":8501.97,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":8178.51,"10th_percentile":8178.51,"90th_percentile":8178.51,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":31607.28,"10th_percentile":31607.28,"90th_percentile":31607.28},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":35821.66,"10th_percentile":35821.66,"90th_percentile":35821.66},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":30503.58,"10th_percentile":30503.58,"90th_percentile":30575.48,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"1 through 10","median_amount":58153.84,"10th_percentile":58153.84,"90th_percentile":58153.84,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","code_information":[{"code":"279","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20454.89,"maximum":111708.24,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":91133.73},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":91133.73},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":73170.25},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71186.73},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27273.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27273.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20454.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":111708.24},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70381.06}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23835.81,"10th_percentile":23835.81,"90th_percentile":26723.45,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Cc","code_information":[{"code":"271","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20173.48,"maximum":110156.39,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":89867.7},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":89867.7},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":72153.77},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70197.81},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26897.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26897.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20173.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110156.39},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69403.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":87039.99,"10th_percentile":87039.99,"90th_percentile":87039.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":66480.1,"10th_percentile":66480.1,"90th_percentile":66480.1,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":30620.36,"10th_percentile":30620.36,"90th_percentile":30620.36,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25375.7,"10th_percentile":25368.78,"90th_percentile":25669.79,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein Ligation And Stripping","code_information":[{"code":"263","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17371.26,"maximum":94702.97,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":77260.5},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":77260.5},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":62031.59},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60350.02},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23161.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23161.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17371.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94702.97},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59667.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20655.05,"10th_percentile":20655.05,"90th_percentile":20655.05,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma Without Cc/Mcc","code_information":[{"code":"185","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4616.06,"maximum":24361.84,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19874.86},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19874.86},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15957.3},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15524.72},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6154.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6154.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4616.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24361.84},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15349.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5879.77,"10th_percentile":5879.77,"90th_percentile":5879.77,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Mcc","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8975.82,"maximum":48404.63,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":39489.43},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39489.43},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31705.62},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30846.14},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11967.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11967.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8975.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48404.63},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30497.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":16151.86,"10th_percentile":16151.86,"90th_percentile":16151.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":32797.17,"10th_percentile":32797.17,"90th_percentile":32797.17,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8287.12,"10th_percentile":8287.12,"90th_percentile":8287.12,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9941.88,"10th_percentile":7899.79,"90th_percentile":12041.88,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8287.12,"10th_percentile":8287.12,"90th_percentile":8287.12,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8287.12,"10th_percentile":8287.12,"90th_percentile":8287.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"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":10459.46,"10th_percentile":10459.46,"90th_percentile":10459.46,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":13702.74,"10th_percentile":13702.74,"90th_percentile":13702.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10400.54,"10th_percentile":10084.08,"90th_percentile":12060.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":85641.02,"10th_percentile":85641.02,"90th_percentile":85641.02},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8287.12,"10th_percentile":8287.12,"90th_percentile":8287.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":47686.75,"10th_percentile":47686.75,"90th_percentile":47686.75,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Cc","code_information":[{"code":"164","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14375.26,"maximum":78180.9,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":63781.48},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":63781.48},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":51209.44},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49821.24},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19167.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19167.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14375.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78180.9},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49257.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":63604.59,"10th_percentile":63604.59,"90th_percentile":63604.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":51067.41,"10th_percentile":51067.41,"90th_percentile":51067.41,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":167096.73,"10th_percentile":167096.73,"90th_percentile":167096.73},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":87360.43,"10th_percentile":87360.43,"90th_percentile":87360.43},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri Without Mcc","code_information":[{"code":"153","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4344.76,"maximum":22865.75,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18654.31},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18654.31},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14977.34},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14571.33},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5793.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5793.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4344.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22865.75},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14406.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4207.59,"10th_percentile":4207.59,"90th_percentile":4207.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","code_information":[{"code":"145","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6951.52,"maximum":37241.24,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30382.12},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30382.12},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24393.46},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23732.2},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9268.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9268.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6951.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37241.24},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23463.61}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures With Cc/Mcc","code_information":[{"code":"137","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8585.45,"maximum":46251.87,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":37733.16},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37733.16},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30295.53},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29474.27},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11447.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11447.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8585.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46251.87},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29140.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10293.38,"10th_percentile":10293.38,"90th_percentile":10293.38,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures Without Cc/Mcc","code_information":[{"code":"117","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6292.11,"maximum":33604.78,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27415.42},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27415.42},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22011.54},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21414.84},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8389.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8389.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6292.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33604.78},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21172.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Mcc","code_information":[{"code":"070","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9549.29,"maximum":51567.18,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":42069.5},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":42069.5},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33777.13},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32861.49},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12732.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12732.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9549.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51567.18},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32489.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":43179.48,"10th_percentile":43179.48,"90th_percentile":43179.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":35278.51,"10th_percentile":35278.51,"90th_percentile":35278.51,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":12509.3,"10th_percentile":12509.3,"90th_percentile":12509.3,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","code_information":[{"code":"062","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10068.29,"maximum":54429.27,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":44404.44},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":44404.44},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":35651.83},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34685.37},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13424.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13424.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10068.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54429.27},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34292.81}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":44280.0,"10th_percentile":44280.0,"90th_percentile":44280.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13244.89,"10th_percentile":13244.89,"90th_percentile":13244.89,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":11332.92,"10th_percentile":11332.92,"90th_percentile":11332.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms With Mcc","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8774.74,"maximum":47295.73,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":38584.76},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":38584.76},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30979.27},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30139.48},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11699.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11699.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8774.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47295.73},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29798.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":10014.98,"10th_percentile":10014.98,"90th_percentile":10014.98,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11134.75,"10th_percentile":8912.72,"90th_percentile":11147.8,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":4065.6,"10th_percentile":4065.6,"90th_percentile":4065.6},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":41342.1,"10th_percentile":41342.1,"90th_percentile":41342.1,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Mcc","code_information":[{"code":"380","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11219.74,"maximum":60779.15,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":49584.79},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":49584.79},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":39811.08},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38731.87},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14959.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14959.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11219.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60779.15},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38293.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":40051.95,"10th_percentile":40051.95,"90th_percentile":40051.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12315.73,"10th_percentile":12315.73,"90th_percentile":12315.73,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Mcc","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8493.34,"maximum":45743.88,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":37318.74},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37318.74},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29962.8},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29150.56},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11324.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11324.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8493.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45743.88},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28820.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":37144.37,"10th_percentile":37144.37,"90th_percentile":37144.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":29822.8,"10th_percentile":29822.8,"90th_percentile":29822.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7958.42,"10th_percentile":7958.42,"90th_percentile":7958.42,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10969.13,"10th_percentile":10969.13,"90th_percentile":10969.13,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7958.42,"10th_percentile":7958.42,"90th_percentile":7958.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10927.15,"10th_percentile":10927.15,"90th_percentile":10927.15,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Mcc","code_information":[{"code":"397","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13650.13,"maximum":74182.03,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":60519.12},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":60519.12},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":48590.13},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47272.93},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18200.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18200.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13650.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74182.03},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46737.91}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17616.53,"10th_percentile":17616.53,"90th_percentile":17616.53,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","code_information":[{"code":"409","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12427.91,"maximum":67441.87,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":55020.37},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":55020.37},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":44175.24},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42977.72},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16570.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16570.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12427.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67441.87},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42491.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15644.69,"10th_percentile":15644.69,"90th_percentile":15644.69,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","code_information":[{"code":"251","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8592.75,"maximum":46292.14,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":37766.02},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37766.02},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30321.91},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29499.94},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11457.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11457.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8592.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46292.14},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29166.06}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","code_information":[{"code":"239","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27842.68,"maximum":152449.66,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":124371.36},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":124371.36},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":99856.37},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":97149.44},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37123.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37123.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27842.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":152449.66},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":96049.93}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":74788.37,"10th_percentile":74788.37,"90th_percentile":74788.37,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures With Mcc","code_information":[{"code":"228","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27987.03,"maximum":153245.72,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":125020.8},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":125020.8},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":100377.8},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":97656.73},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37316.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37316.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27987.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":153245.72},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":96551.48}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":90661.92,"10th_percentile":90661.92,"90th_percentile":90661.92,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36671.77,"10th_percentile":36671.77,"90th_percentile":37091.38,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43332.58,"10th_percentile":43332.58,"90th_percentile":43332.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Abdominal Aorta With Iliac Branch Procedures","code_information":[{"code":"213","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32252.99,"maximum":176771.23,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":144213.36},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":144213.36},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":115787.29},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":112648.5},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43003.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43003.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32252.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":176771.23},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":111373.58}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma Without Cc/Mcc","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3961.7,"maximum":20753.25,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16930.9},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16930.9},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13593.63},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13225.13},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5282.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5282.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3961.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20753.25},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13075.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":7696.57,"10th_percentile":7696.57,"90th_percentile":7696.57,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4081.03,"10th_percentile":4081.03,"90th_percentile":7086.92,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5275.41,"10th_percentile":5275.41,"90th_percentile":5275.41,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4321.11,"10th_percentile":4321.11,"90th_percentile":4321.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy Without Cc/Mcc","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3728.6,"maximum":19467.79,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15882.2},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15882.2},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12751.64},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12405.96},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4971.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4971.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3728.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19467.79},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12265.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4252.94,"10th_percentile":4252.94,"90th_percentile":4252.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"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":3228.82,"10th_percentile":3228.82,"90th_percentile":3228.82,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":4106.89,"10th_percentile":4106.89,"90th_percentile":4106.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Cc","code_information":[{"code":"187","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5754.02,"maximum":30637.37,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24994.56},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24994.56},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20067.85},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19523.84},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7672.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7672.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5754.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30637.37},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19302.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":26966.16,"10th_percentile":26966.16,"90th_percentile":26966.16,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9846.33,"10th_percentile":9846.33,"90th_percentile":9846.33,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7517.86,"10th_percentile":7517.86,"90th_percentile":7517.86,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":20618.63,"10th_percentile":20618.63,"90th_percentile":20618.63},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures Without Mcc","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5268.16,"maximum":27958.04,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22808.7},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22808.7},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18312.85},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17816.42},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7024.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7024.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5268.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27958.04},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17614.78}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":23291.36,"10th_percentile":23291.36,"90th_percentile":23291.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":19173.93,"10th_percentile":19173.93,"90th_percentile":19173.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5759.76,"10th_percentile":4620.61,"90th_percentile":5759.76,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6918.92,"10th_percentile":6572.63,"90th_percentile":6987.84,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":5269.44,"10th_percentile":5269.44,"90th_percentile":5269.44,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6950.38,"10th_percentile":6950.38,"90th_percentile":6950.38,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5759.76,"10th_percentile":5759.76,"90th_percentile":5759.76,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":14403.8,"10th_percentile":14403.8,"90th_percentile":14403.8},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":36636.57,"10th_percentile":36636.57,"90th_percentile":36636.57,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":16920.58,"10th_percentile":16920.58,"90th_percentile":16920.58,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System Without Cc/Mcc","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4671.1,"maximum":24665.39,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20122.5},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20122.5},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16156.13},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15718.17},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6228.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6228.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4671.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24665.39},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15540.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6123.64,"10th_percentile":6123.64,"90th_percentile":6123.64,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":18073.91,"10th_percentile":18073.91,"90th_percentile":18073.91},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Mcc","code_information":[{"code":"085","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12959.26,"maximum":70372.1,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":57410.91},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":57410.91},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":46094.58},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44845.03},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17279.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17279.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12959.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70372.1},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44337.49}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16794.66,"10th_percentile":16794.66,"90th_percentile":16902.74,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15134.93,"10th_percentile":15134.93,"90th_percentile":15134.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":67990.41,"10th_percentile":67990.41,"90th_percentile":67990.41},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":41953.44,"10th_percentile":41953.44,"90th_percentile":41953.44,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders Without Mcc","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5988.24,"maximum":31929.03,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26048.32},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26048.32},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20913.9},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20346.96},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7984.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7984.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5988.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31929.03},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20116.68}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":55890.71,"10th_percentile":55890.71,"90th_percentile":55890.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":355.52,"10th_percentile":355.52,"90th_percentile":355.52,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6442.94,"10th_percentile":5724.63,"90th_percentile":6442.94,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7722.25,"10th_percentile":7722.25,"90th_percentile":7722.25,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":7794.65,"10th_percentile":7794.65,"90th_percentile":7794.65,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6442.94,"10th_percentile":6442.94,"90th_percentile":6442.94,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":4317.56,"10th_percentile":4317.56,"90th_percentile":4317.56,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures Without Cc/Mcc","code_information":[{"code":"030","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12528.45,"maximum":67996.32,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":55472.7},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":55472.7},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":44538.41},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43331.05},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16704.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16704.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12528.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67996.32},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42840.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":13831.1,"10th_percentile":13831.1,"90th_percentile":13831.1,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","code_information":[{"code":"022","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18045.28,"maximum":98419.97,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":80292.9},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":80292.9},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":64466.27},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62718.7},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24060.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24060.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18045.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98419.97},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62008.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","code_information":[{"code":"013","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16384.95,"maximum":89263.76,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":72823.09},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":72823.09},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":58468.84},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56883.85},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21846.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21846.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16384.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89263.76},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56240.06}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","code_information":[{"code":"004","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":77999.08,"maximum":429047.12,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":350024.88},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":350024.88},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":281031.05},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":273412.78},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":103998.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":103998.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77999.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":429047.12},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":270318.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":286683.57,"10th_percentile":286683.57,"90th_percentile":313732.92,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":228196.32,"10th_percentile":228196.32,"90th_percentile":228196.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":103550.42,"10th_percentile":103550.42,"90th_percentile":103550.42,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","code_information":[{"code":"416","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7855.83,"maximum":42228.22,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":34450.59},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":34450.59},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":27659.99},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26910.18},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10474.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10474.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7855.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42228.22},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26605.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","code_information":[{"code":"424","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12487.45,"maximum":67770.2,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":55288.23},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":55288.23},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":44390.3},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43186.96},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16649.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16649.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12487.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67770.2},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42698.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Cc","code_information":[{"code":"433","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6130.9,"maximum":32715.8,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26690.17},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26690.17},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21429.24},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20848.33},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8174.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8174.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6130.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32715.8},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20612.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":22346.2,"10th_percentile":22346.2,"90th_percentile":27033.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":20278.6,"10th_percentile":20278.6,"90th_percentile":34897.17,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5684.81,"10th_percentile":5684.81,"90th_percentile":5684.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","code_information":[{"code":"441","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10278.92,"maximum":55590.83,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":45352.07},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":45352.07},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36412.67},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35425.58},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13705.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13705.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10278.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55590.83},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35024.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":23765.48,"10th_percentile":23765.48,"90th_percentile":23765.48,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14004.18,"10th_percentile":13990.22,"90th_percentile":14123.53,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":25452.97,"10th_percentile":25452.97,"90th_percentile":25452.97,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":1801.89,"10th_percentile":1801.89,"90th_percentile":1801.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"450","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30133.77,"maximum":165084.36,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":134678.99},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":134678.99},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":108132.25},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":105200.97},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40178.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40178.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30133.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":165084.36},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":104010.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37186.55,"10th_percentile":37186.55,"90th_percentile":37186.55,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement Or Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With","code_information":[{"code":"464","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17693.11,"maximum":96477.83,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":78708.47},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":78708.47},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":63194.15},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61481.06},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23590.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23590.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17693.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96477.83},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60785.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":12772.67,"10th_percentile":12772.67,"90th_percentile":12772.67,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21189.65,"10th_percentile":21189.65,"90th_percentile":21189.65,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":21858.77,"10th_percentile":21858.77,"90th_percentile":21858.77,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":20373.96,"10th_percentile":20373.96,"90th_percentile":20373.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Cc","code_information":[{"code":"472","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16746.11,"maximum":91255.45,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":74447.95},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":74447.95},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":59773.42},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58153.07},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22328.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22328.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16746.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91255.45},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57494.91}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":74861.22,"10th_percentile":74861.22,"90th_percentile":74861.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":17700.12,"10th_percentile":17700.12,"90th_percentile":17700.12,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19656.52,"10th_percentile":19656.52,"90th_percentile":19656.52,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":17700.12,"10th_percentile":17700.12,"90th_percentile":17700.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"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":20235.62,"10th_percentile":20235.62,"90th_percentile":20235.62,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":77917.75,"10th_percentile":77917.75,"90th_percentile":77917.75,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Mcc Or Insertion Of Antibiotic-Eluting Bone Void Fi","code_information":[{"code":"480","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16556.26,"maximum":90208.49,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":73593.82},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":73593.82},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":59087.65},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57485.89},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22075.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22075.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16556.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90208.49},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56835.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":59669.95,"10th_percentile":59669.95,"90th_percentile":59669.95,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":22211.43,"10th_percentile":22211.43,"90th_percentile":22211.43,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21343.39,"10th_percentile":19977.04,"90th_percentile":21877.72,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":16225.33,"10th_percentile":16225.33,"90th_percentile":16225.33,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":16693.88,"10th_percentile":16693.88,"90th_percentile":16693.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21706.76,"10th_percentile":21706.76,"90th_percentile":21706.76,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":173330.0,"10th_percentile":173330.0,"90th_percentile":173330.0},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":64886.89,"10th_percentile":64886.89,"90th_percentile":64886.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"489","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6471.28,"maximum":34592.88,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28221.54},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28221.54},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22658.76},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22044.52},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8628.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8628.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6471.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34592.88},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21795.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":41310.5,"10th_percentile":41310.5,"90th_percentile":41310.5,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","code_information":[{"code":"499","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11515.18,"maximum":62408.43,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":50914.0},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":50914.0},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":40878.28},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39770.14},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15353.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15353.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11515.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62408.43},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39320.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","code_information":[{"code":"507","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10344.64,"maximum":55953.24,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":45647.73},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":45647.73},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36650.05},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35656.53},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13792.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13792.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10344.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55953.24},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35252.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":92092.14,"10th_percentile":92092.14,"90th_percentile":92092.14,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","code_information":[{"code":"516","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11870.72,"maximum":64369.15,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":52513.59},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":52513.59},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":42162.57},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41019.62},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15827.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15827.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11870.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64369.15},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40555.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":70537.66,"10th_percentile":70537.66,"90th_percentile":70537.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":30899.27,"10th_percentile":30899.27,"90th_percentile":30899.27},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"1 through 10","median_amount":37143.73,"10th_percentile":37143.73,"90th_percentile":37143.73,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur Without Mcc","code_information":[{"code":"534","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4726.14,"maximum":24968.95,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20370.15},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20370.15},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16354.96},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15911.61},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6301.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6301.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4726.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24968.95},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15731.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":6178.93,"10th_percentile":6178.93,"90th_percentile":6178.93,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders With Cc/Mcc","code_information":[{"code":"600","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6048.9,"maximum":32263.56,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26321.23},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26321.23},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21133.02},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20560.14},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8065.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8065.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6048.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32263.56},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20327.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4172.45,"10th_percentile":4172.45,"90th_percentile":4172.45,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures With Cc/Mcc","code_information":[{"code":"614","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12509.36,"maximum":67891.01,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":55386.79},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":55386.79},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":44469.43},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43263.94},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16679.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16679.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12509.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67891.01},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42774.29}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":21606.93,"10th_percentile":21606.93,"90th_percentile":21606.93,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":70585.83,"10th_percentile":70585.83,"90th_percentile":70585.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"622","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20189.78,"maximum":110246.22,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":89940.98},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":89940.98},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":72212.61},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70255.05},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26919.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26919.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20189.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110246.22},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69459.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","code_information":[{"code":"630","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8396.17,"maximum":45208.01,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":36881.57},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":36881.57},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29611.8},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28809.07},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11194.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11194.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8396.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45208.01},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28483.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","code_information":[{"code":"804","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7814.83,"maximum":42002.1,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":34266.12},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":34266.12},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":27511.88},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26766.08},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10419.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10419.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7814.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42002.1},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26463.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":22445.83,"10th_percentile":22445.83,"90th_percentile":22445.83,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Without Mcc","code_information":[{"code":"812","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5355.79,"maximum":28441.25,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23202.91},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23202.91},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18629.36},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18124.35},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7141.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7141.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5355.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28441.25},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17919.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":18724.72,"10th_percentile":18724.72,"90th_percentile":18724.72,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5904.99,"10th_percentile":5904.99,"90th_percentile":5904.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6193.87,"10th_percentile":6193.87,"90th_percentile":6193.87,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6920.68,"10th_percentile":6577.68,"90th_percentile":6931.6,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":5325.04,"10th_percentile":5325.04,"90th_percentile":5325.04,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"14","median_amount":6035.39,"10th_percentile":4537.24,"90th_percentile":8420.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6568.52,"10th_percentile":6568.52,"90th_percentile":6568.52,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":109058.15,"10th_percentile":109058.15,"90th_percentile":109058.15,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","code_information":[{"code":"820","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33139.89,"maximum":181662.18,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":148203.5},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":148203.5},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":118990.93},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":115765.29},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44186.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44186.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33139.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":181662.18},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":114455.09}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Cc","code_information":[{"code":"644","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5955.66,"maximum":31749.38,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25901.75},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25901.75},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20796.23},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20232.48},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7940.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7940.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5955.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31749.38},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20003.49}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7780.85,"10th_percentile":7742.84,"90th_percentile":7842.39,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5103.91,"10th_percentile":5103.91,"90th_percentile":5103.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6086.36,"10th_percentile":6086.36,"90th_percentile":6086.36,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Mcc","code_information":[{"code":"656","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18081.22,"maximum":98618.21,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":80454.63},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":80454.63},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":64596.12},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62845.03},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24108.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24108.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18081.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98618.21},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62133.77}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":37898.8,"10th_percentile":37898.8,"90th_percentile":37898.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":55562.54,"10th_percentile":55562.54,"90th_percentile":55562.54,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures Without Cc/Mcc","code_information":[{"code":"664","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6078.67,"maximum":32427.73,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26455.16},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26455.16},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21240.55},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20664.76},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8104.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8104.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6078.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32427.73},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20430.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6821.39,"10th_percentile":6821.39,"90th_percentile":6821.39,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures Without Cc/Mcc","code_information":[{"code":"672","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6261.78,"maximum":33437.51,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27278.97},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27278.97},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21901.98},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21308.25},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8349.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8349.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6261.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33437.51},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21067.09}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8186.36,"10th_percentile":8186.36,"90th_percentile":8186.36,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Cc","code_information":[{"code":"687","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6083.72,"maximum":32455.61,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26477.91},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26477.91},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21258.81},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20682.52},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8111.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8111.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6083.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32455.61},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20448.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":19725.0,"10th_percentile":19725.0,"90th_percentile":19725.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7208.39,"10th_percentile":7208.39,"90th_percentile":7208.39,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6851.28,"10th_percentile":6851.28,"90th_percentile":6851.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Stricture","code_information":[{"code":"697","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6252.23,"maximum":33384.86,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27236.01},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27236.01},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21867.48},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21274.69},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8336.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8336.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6252.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33384.86},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21033.91}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","code_information":[{"code":"542","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10120.52,"maximum":54717.34,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":44639.46},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":44639.46},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":35840.52},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34868.94},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13494.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13494.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10120.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54717.34},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34474.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12096.52,"10th_percentile":10780.64,"90th_percentile":13975.34,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":13852.57,"10th_percentile":13852.57,"90th_percentile":13852.57,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":74457.57,"10th_percentile":74457.57,"90th_percentile":74457.57},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis Without Cc/Mcc","code_information":[{"code":"550","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5108.08,"maximum":27075.25,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22088.51},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22088.51},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17734.61},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17253.86},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6810.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6810.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5108.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27075.25},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17058.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis Without Mcc","code_information":[{"code":"558","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5215.36,"maximum":27666.87,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22571.16},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22571.16},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18122.13},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17630.87},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6953.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6953.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5215.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27666.87},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17431.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":22588.5,"10th_percentile":22588.5,"90th_percentile":22588.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":86395.37,"10th_percentile":86395.37,"90th_percentile":86395.37,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5311.6,"10th_percentile":5311.6,"90th_percentile":5311.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6168.46,"10th_percentile":6168.46,"90th_percentile":6491.93,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":12227.61,"10th_percentile":12227.61,"90th_percentile":12227.61},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy Without Cc/Mcc","code_information":[{"code":"714","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6137.65,"maximum":32752.97,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26720.5},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26720.5},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21453.59},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20872.02},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8183.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8183.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6137.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32752.97},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20635.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8018.61,"10th_percentile":8018.61,"90th_percentile":8018.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy With Mcc","code_information":[{"code":"725","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6771.22,"maximum":36246.95,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":29570.95},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29570.95},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23742.19},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23098.58},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9028.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9028.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6771.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36246.95},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22837.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","code_information":[{"code":"736","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20275.71,"maximum":110720.14,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":90327.62},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":90327.62},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":72523.03},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70557.06},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27034.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27034.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20275.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110720.14},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69758.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","code_information":[{"code":"744","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11707.84,"maximum":63470.87,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":51780.76},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":51780.76},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":41574.19},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40447.18},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15610.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15610.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11707.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63470.87},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39989.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":10298.42,"10th_percentile":10298.42,"90th_percentile":10298.42,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":14503.1,"10th_percentile":14503.1,"90th_percentile":14503.1,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"574","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19696.62,"maximum":107526.62,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":87722.28},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":87722.28},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":70431.23},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68521.96},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26262.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26262.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19696.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107526.62},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67746.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4836.34,"10th_percentile":4836.34,"90th_percentile":4836.34,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25563.41,"10th_percentile":25563.41,"90th_percentile":25563.41,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy With Cc/Mcc","code_information":[{"code":"582","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11019.77,"maximum":59676.44,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":48685.18},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":48685.18},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":39088.79},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38029.16},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14693.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14693.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11019.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59676.44},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37598.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders Without Mcc","code_information":[{"code":"596","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6278.63,"maximum":33530.44,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27354.78},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27354.78},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21962.84},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21367.47},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8371.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8371.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6278.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33530.44},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21125.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":16625.47,"10th_percentile":16625.47,"90th_percentile":16625.47,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures With Cc/Mcc","code_information":[{"code":"749","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14620.15,"maximum":79531.41,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":64883.25},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":64883.25},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":52094.04},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50681.86},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19493.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19493.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14620.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79531.41},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50108.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","code_information":[{"code":"760","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5857.36,"maximum":31207.31,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25459.53},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25459.53},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20441.17},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19887.04},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7809.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7809.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5857.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31207.31},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19661.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":24906.11,"10th_percentile":24906.11,"90th_percentile":24906.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":29072.25,"10th_percentile":29072.25,"90th_percentile":29072.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Cc","code_information":[{"code":"784","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6152.81,"maximum":32836.6,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26788.73},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26788.73},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21508.37},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20925.31},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8203.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8203.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6152.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32836.6},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20688.49}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":22805.0,"10th_percentile":22805.0,"90th_percentile":22805.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":20371.0,"10th_percentile":20371.0,"90th_percentile":30866.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5526.31,"10th_percentile":5380.05,"90th_percentile":5526.31,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9243.22,"10th_percentile":9243.22,"90th_percentile":9243.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":38542.64,"10th_percentile":38542.64,"90th_percentile":38542.64,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity Without Major Problems","code_information":[{"code":"792","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13955.12,"maximum":75863.97,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":61891.28},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":61891.28},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":49691.82},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48344.76},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18606.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18606.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13955.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75863.97},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47797.61}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"14","median_amount":12803.13,"10th_percentile":5285.53,"90th_percentile":61040.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":8545.31,"10th_percentile":7346.0,"90th_percentile":58768.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2281.64,"10th_percentile":2281.64,"90th_percentile":2281.64,"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":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"33","median_amount":5143.73,"10th_percentile":2248.63,"90th_percentile":13559.31,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":10013.03,"10th_percentile":10013.03,"90th_percentile":10013.03,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9872.87,"10th_percentile":9872.87,"90th_percentile":9872.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":18752.96,"10th_percentile":18752.96,"90th_percentile":18752.96},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9872.87,"10th_percentile":9872.87,"90th_percentile":26539.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":158684.03,"10th_percentile":158684.03,"90th_percentile":158684.03},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":5575.23,"10th_percentile":5575.23,"90th_percentile":5575.23,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","code_information":[{"code":"824","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12923.87,"maximum":70176.96,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":57251.71},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":57251.71},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":45966.76},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44720.68},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17231.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17231.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12923.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70176.96},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44214.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":18856.93,"10th_percentile":18856.93,"90th_percentile":18856.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Cc","code_information":[{"code":"832","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4251.52,"maximum":22351.56,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18234.83},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18234.83},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14640.54},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14243.66},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5668.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5668.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4251.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22351.56},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14082.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":18234.83,"10th_percentile":14211.0,"90th_percentile":24457.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":15164.0,"10th_percentile":15164.0,"90th_percentile":15164.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"24","median_amount":3074.68,"10th_percentile":3031.51,"90th_percentile":3074.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5530.27,"10th_percentile":5530.27,"90th_percentile":5530.27,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":3532.27,"10th_percentile":3532.27,"90th_percentile":3532.27},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":18629.21,"10th_percentile":18629.21,"90th_percentile":18629.21,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":8037.42,"10th_percentile":8037.42,"90th_percentile":8037.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Mcc","code_information":[{"code":"840","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18368.24,"maximum":100201.03,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":81745.92},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":81745.92},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":65632.89},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63853.69},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24490.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24490.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18368.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100201.03},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63131.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23535.93,"10th_percentile":21575.93,"90th_percentile":23708.15,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":23540.36,"10th_percentile":23540.36,"90th_percentile":23540.36,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":83582.58,"10th_percentile":54393.03,"90th_percentile":84812.65,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"848","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4969.35,"maximum":26310.17,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21464.34},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21464.34},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17233.48},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16766.31},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6625.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6625.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4969.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26310.17},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16576.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"858","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8022.08,"maximum":43145.08,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35198.58},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35198.58},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28260.55},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27494.45},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10696.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10696.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8022.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43145.08},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27183.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","code_information":[{"code":"869","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4297.02,"maximum":22602.46,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18439.52},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18439.52},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14804.88},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14403.55},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5729.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5729.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4297.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22602.46},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14240.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":12642.9,"10th_percentile":12642.9,"90th_percentile":12642.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Personality And Impulse Control","code_information":[{"code":"883","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11242.76,"maximum":60906.14,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":49688.4},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":49688.4},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":39894.26},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38812.8},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14990.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14990.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11242.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60906.14},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38373.52}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":13935.41,"10th_percentile":13935.41,"90th_percentile":13935.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":15189.93,"10th_percentile":5719.03,"90th_percentile":20278.3,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"19","median_amount":6553.34,"10th_percentile":6456.06,"90th_percentile":6553.34,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13005.45,"10th_percentile":13005.45,"90th_percentile":13005.45,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6553.34,"10th_percentile":6553.34,"90th_percentile":6553.34,"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":"ICare","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":13100.7,"10th_percentile":13100.7,"90th_percentile":13100.7,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3720.74,"10th_percentile":3720.74,"90th_percentile":3720.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13140.85,"10th_percentile":13140.85,"90th_percentile":13140.85,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":18512.34,"10th_percentile":18512.34,"90th_percentile":18512.34,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","code_information":[{"code":"897","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5156.96,"maximum":27344.73,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22308.36},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22308.36},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17911.13},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17425.59},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6875.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6875.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5156.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27344.73},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17228.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":20893.19,"10th_percentile":13094.75,"90th_percentile":30430.14,"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":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"12","median_amount":17898.96,"10th_percentile":16129.68,"90th_percentile":17898.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"45","median_amount":7885.65,"10th_percentile":5843.62,"90th_percentile":7885.65,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6288.39,"10th_percentile":6288.39,"90th_percentile":6634.07,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6797.98,"10th_percentile":5843.62,"90th_percentile":7885.65,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":10200.72,"10th_percentile":10200.72,"90th_percentile":10200.72},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7885.65,"10th_percentile":6244.15,"90th_percentile":7885.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"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":6770.9,"10th_percentile":6770.9,"90th_percentile":6770.9,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6553.34,"10th_percentile":6553.34,"90th_percentile":6553.34,"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","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4380.92,"10th_percentile":3246.45,"90th_percentile":12342.15,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":17774.92,"10th_percentile":17774.92,"90th_percentile":17774.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":7256.21,"10th_percentile":7256.21,"90th_percentile":7256.21,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Cc","code_information":[{"code":"908","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11405.09,"maximum":61801.32,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":50418.7},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":50418.7},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":40480.61},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39383.25},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15206.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15206.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11405.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61801.32},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38937.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":40924.94,"10th_percentile":40924.94,"90th_percentile":47520.94,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":11659.16,"10th_percentile":11659.16,"90th_percentile":11659.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12459.63,"10th_percentile":12459.63,"90th_percentile":12459.63,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":30296.96,"10th_percentile":30296.96,"90th_percentile":31920.62,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"1 through 10","median_amount":56619.23,"10th_percentile":56619.23,"90th_percentile":56619.23,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Mcc","code_information":[{"code":"919","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10481.68,"maximum":56709.03,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":46264.32},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":46264.32},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":37145.1},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36138.16},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13975.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13975.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10481.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56709.03},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35729.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":16430.16,"10th_percentile":16430.16,"90th_percentile":16430.16,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":12936.63,"10th_percentile":12936.63,"90th_percentile":12936.63,"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":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9195.16,"10th_percentile":9195.16,"90th_percentile":9195.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13522.35,"10th_percentile":13521.99,"90th_percentile":13693.89,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":17087.94,"10th_percentile":17087.94,"90th_percentile":17087.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13693.89,"10th_percentile":13693.89,"90th_percentile":13693.89,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":170025.77,"10th_percentile":170025.77,"90th_percentile":170025.77},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":32134.45,"10th_percentile":32134.45,"90th_percentile":32134.45,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","code_information":[{"code":"939","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20579.02,"maximum":112392.79,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":91692.2},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":91692.2},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":73618.64},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71622.96},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27438.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27438.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20579.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112392.79},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70812.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare Without Cc/Mcc","code_information":[{"code":"950","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3724.1,"maximum":19443.01,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15861.98},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15861.98},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12735.41},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12390.17},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4965.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4965.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3724.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19443.01},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12249.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Cc","code_information":[{"code":"964","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8806.76,"maximum":47472.29,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":38728.8},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":38728.8},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31094.92},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30251.99},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11742.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11742.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8806.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47472.29},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29909.61}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":37907.53,"10th_percentile":37907.53,"90th_percentile":37907.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":32557.02,"10th_percentile":32557.02,"90th_percentile":32557.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8077.88,"10th_percentile":8077.88,"90th_percentile":8077.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11183.11,"10th_percentile":11183.11,"90th_percentile":11183.11,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"1 through 10","median_amount":81374.76,"10th_percentile":81374.76,"90th_percentile":81374.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"981","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26551.37,"maximum":145328.51,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":118561.79},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":118561.79},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":95191.93},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":92611.44},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35401.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35401.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26551.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":145328.51},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":91563.29}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":149684.05,"10th_percentile":149684.05,"90th_percentile":149684.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":49473.56,"10th_percentile":49473.56,"90th_percentile":49473.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":46876.83,"10th_percentile":46876.83,"90th_percentile":111560.13,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32182.08,"10th_percentile":32182.08,"90th_percentile":35305.12,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":34938.89,"10th_percentile":34938.89,"90th_percentile":34938.89,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34688.25,"10th_percentile":34688.25,"90th_percentile":34688.25,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":72311.35,"10th_percentile":72311.35,"90th_percentile":72311.35},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":17750.35,"10th_percentile":17750.35,"90th_percentile":17750.35},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","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","minimum":74215.13,"maximum":118969.54,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":92435.13},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":74215.13},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":118969.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Cc","code_information":[{"code":"095","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14685.31,"maximum":79890.72,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":65176.38},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":65176.38},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":52329.39},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50910.83},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19580.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19580.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14685.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79890.72},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50334.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","code_information":[{"code":"087","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5336.13,"maximum":28332.83,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23114.47},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23114.47},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18558.35},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18055.26},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7114.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7114.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5336.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28332.83},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17850.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":22338.68,"10th_percentile":22338.68,"90th_percentile":22338.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6640.24,"10th_percentile":6640.24,"90th_percentile":6640.24,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":50229.11,"10th_percentile":50229.11,"90th_percentile":50229.11},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis Without Cc/Mcc","code_information":[{"code":"076","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4833.43,"maximum":25560.57,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20852.8},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20852.8},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16742.48},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16288.62},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6444.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6444.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4833.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25560.57},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16104.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Cc","code_information":[{"code":"032","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12167.85,"maximum":66007.73,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":53850.37},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":53850.37},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":43235.86},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42063.81},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16223.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16223.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12167.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66007.73},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41587.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":13362.63,"10th_percentile":13362.63,"90th_percentile":13362.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16296.81,"10th_percentile":16296.81,"90th_percentile":16296.81,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14325.24,"10th_percentile":14325.24,"90th_percentile":14325.24,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","code_information":[{"code":"024","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22170.82,"maximum":121171.1,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":98853.71},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":98853.71},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":79368.54},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":77216.99},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29561.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29561.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22170.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":121171.1},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":76343.08}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":96068.96,"10th_percentile":96068.96,"90th_percentile":96068.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":77132.69,"10th_percentile":77132.69,"90th_percentile":77132.69,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26259.93,"10th_percentile":26259.93,"90th_percentile":26259.93,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":29110.34,"10th_percentile":29110.34,"90th_percentile":29110.34,"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":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant With Cc/Mcc","code_information":[{"code":"016","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33504.42,"maximum":183672.46,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":149843.52},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":149843.52},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":120307.68},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":117046.35},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44672.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44672.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33504.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":183672.46},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":115721.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant Without Mcc","code_information":[{"code":"006","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26243.57,"maximum":143631.08,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":117176.99},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":117176.99},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":94080.09},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":91529.74},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34991.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34991.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26243.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":143631.08},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":90493.84}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","code_information":[{"code":"414","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20208.87,"maximum":110351.54,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":90026.9},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":90026.9},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":72281.59},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70322.16},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26945.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26945.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20208.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110351.54},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69526.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":14115.6,"10th_percentile":14115.6,"90th_percentile":14115.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","code_information":[{"code":"422","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8059.16,"maximum":43349.51,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35365.37},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35365.37},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28394.46},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27624.73},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10745.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10745.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8059.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43349.51},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27312.08}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","code_information":[{"code":"430","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32591.12,"maximum":178635.92,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":145734.62},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":145734.62},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":117008.69},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":113836.79},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43454.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43454.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32591.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":178635.92},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":112548.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":40201.9,"10th_percentile":40201.9,"90th_percentile":40201.9,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Cc","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4923.29,"maximum":26056.17,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21257.12},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21257.12},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17067.11},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16604.45},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6564.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6564.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4923.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26056.17},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16416.52}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":30856.12,"10th_percentile":30856.12,"90th_percentile":30856.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":15498.92,"10th_percentile":14252.6,"90th_percentile":17869.61,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"16","median_amount":5604.39,"10th_percentile":4241.94,"90th_percentile":5604.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6459.24,"10th_percentile":5090.12,"90th_percentile":6497.12,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9201.41,"10th_percentile":9201.41,"90th_percentile":9201.41,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5604.39,"10th_percentile":5604.39,"90th_percentile":5604.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":26644.7,"10th_percentile":26644.7,"90th_percentile":26644.7,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"447","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37727.69,"maximum":206962.56,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":168844.03},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":168844.03},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":135562.98},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":131888.1},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50303.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50303.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37727.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":206962.56},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":130395.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","code_information":[{"code":"462","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15139.14,"maximum":82393.5,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":67218.2},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":67218.2},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":53968.74},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52505.74},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20185.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20185.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15139.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82393.5},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51911.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","code_information":[{"code":"470","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11032.7,"maximum":59747.68,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":48743.3},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":48743.3},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":39135.45},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38074.56},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14710.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14710.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11032.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59747.68},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37643.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":38254.91,"10th_percentile":38254.91,"90th_percentile":38254.91,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13975.33,"10th_percentile":13975.33,"90th_percentile":14420.8,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":13968.33,"10th_percentile":13968.33,"90th_percentile":13968.33,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":766.28,"10th_percentile":766.28,"90th_percentile":766.28,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"478","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14011.29,"maximum":76173.72,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":62143.98},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":62143.98},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":49894.71},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48542.15},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18681.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18681.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14011.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76173.72},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47992.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15716.56,"10th_percentile":15716.56,"90th_percentile":15716.56,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"487","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8995.48,"maximum":48513.05,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":39577.87},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39577.87},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31776.63},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30915.22},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11993.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11993.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8995.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48513.05},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30565.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","code_information":[{"code":"497","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6985.22,"maximum":37427.09,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30533.74},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30533.74},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24515.2},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23850.63},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9313.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9313.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6985.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37427.09},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23580.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9733.57,"10th_percentile":9733.57,"90th_percentile":9733.57,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures Without Cc/Mcc","code_information":[{"code":"505","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10268.25,"maximum":55531.98,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":45304.06},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":45304.06},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36374.12},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35388.08},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13691.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13691.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10268.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55531.98},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34987.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","code_information":[{"code":"514","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5940.5,"maximum":31665.74,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25833.52},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25833.52},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20741.44},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20179.18},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7920.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7920.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5940.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31665.74},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19950.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","code_information":[{"code":"522","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12093.15,"maximum":65595.76,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":53514.28},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":53514.28},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":42966.02},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41801.28},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16124.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16124.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12093.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65595.76},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41328.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15625.22,"10th_percentile":15588.71,"90th_percentile":15969.95,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":15588.71,"10th_percentile":15588.71,"90th_percentile":15588.71,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":98635.38,"10th_percentile":98635.38,"90th_percentile":98635.38},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"1 through 10","median_amount":69719.57,"10th_percentile":69719.57,"90th_percentile":69719.57,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Cc","code_information":[{"code":"540","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7479.5,"maximum":40152.89,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":32757.5},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":32757.5},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26300.63},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25587.67},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9972.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9972.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7479.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40152.89},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25298.07}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":26255.99,"10th_percentile":26255.99,"90th_percentile":26255.99,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders With Mcc","code_information":[{"code":"606","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8697.79,"maximum":46871.37,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":38238.56},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":38238.56},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30701.31},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29869.05},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11597.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11597.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8697.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46871.37},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29531.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":27621.27,"10th_percentile":27621.27,"90th_percentile":27621.27},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Cc","code_information":[{"code":"620","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9187.01,"maximum":49569.29,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":40439.58},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":40439.58},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":32468.49},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31588.32},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12249.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12249.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9187.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49569.29},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31230.81}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":45087.6,"10th_percentile":45087.6,"90th_percentile":45087.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":32401.53,"10th_percentile":32401.53,"90th_percentile":32401.53,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":10504.52,"10th_percentile":10255.24,"90th_percentile":10507.52,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11659.46,"10th_percentile":11659.46,"90th_percentile":11659.46,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9199.85,"10th_percentile":9199.85,"90th_percentile":9199.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":47108.55,"10th_percentile":47108.55,"90th_percentile":47108.55,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc Or Insertion Of Antibiotic-Eluti","code_information":[{"code":"628","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21131.15,"maximum":115437.63,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":94176.24},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":94176.24},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":75613.05},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":73563.31},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28174.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28174.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21131.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":115437.63},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":72730.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","code_information":[{"code":"802","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22576.36,"maximum":123407.5,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":100678.21},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":100678.21},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":80833.4},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":78642.15},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30101.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30101.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22576.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":123407.5},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":77752.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"810","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6076.99,"maximum":32418.44,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26447.58},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26447.58},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21234.47},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20658.84},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8102.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8102.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6076.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32418.44},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20425.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Cc","code_information":[{"code":"818","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6709.44,"maximum":35906.22,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":29292.98},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29292.98},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23519.01},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22881.45},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8945.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8945.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6709.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35906.22},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22622.48}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7800.7,"10th_percentile":7800.7,"90th_percentile":7800.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inborn And Other Disorders Of Metabolism","code_information":[{"code":"642","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8186.1,"maximum":44049.55,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35936.47},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35936.47},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28852.99},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28070.83},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10914.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10914.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8186.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44049.55},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27753.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Cc","code_information":[{"code":"654","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15921.56,"maximum":86708.32,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":70738.31},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":70738.31},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":56795.0},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55255.38},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21228.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21228.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15921.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86708.32},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54630.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20833.28,"10th_percentile":20833.28,"90th_percentile":20833.28,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Mcc","code_information":[{"code":"662","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17394.29,"maximum":94829.96,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":77364.11},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":77364.11},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":62114.77},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60430.95},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23192.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23192.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17394.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94829.96},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59747.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":22998.95,"10th_percentile":22998.95,"90th_percentile":22998.95,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures Without Cc/Mcc","code_information":[{"code":"670","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5687.74,"maximum":30271.87,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24696.37},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24696.37},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19828.44},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19290.92},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7583.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7583.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5687.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30271.87},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19072.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure Without Cc/Mcc","code_information":[{"code":"684","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3570.2,"maximum":18594.29,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15169.58},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15169.58},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12179.49},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11849.32},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4760.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4760.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3570.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18594.29},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11715.21}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4613.27,"10th_percentile":4613.27,"90th_percentile":4613.27,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms With Mcc","code_information":[{"code":"695","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6622.94,"maximum":35429.21,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28903.83},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28903.83},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23206.56},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22577.47},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8830.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8830.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6622.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35429.21},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22321.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8465.77,"10th_percentile":8465.77,"90th_percentile":8465.77,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures With Cc/Mcc","code_information":[{"code":"709","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13269.31,"maximum":72081.92,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":58805.82},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":58805.82},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":47214.53},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45934.63},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17692.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17692.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13269.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72081.92},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45414.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Mcc","code_information":[{"code":"094","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19966.23,"maximum":109013.42,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":88935.24},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":88935.24},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":71405.11},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69469.44},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26621.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26621.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19966.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":109013.42},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68683.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Cc","code_information":[{"code":"086","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7515.45,"maximum":40351.13,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":32919.23},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":32919.23},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26430.48},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25714.0},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10020.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10020.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7515.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40351.13},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25422.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9810.76,"10th_percentile":9810.76,"90th_percentile":9810.76,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8345.68,"10th_percentile":8345.68,"90th_percentile":8345.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8879.52,"10th_percentile":8879.52,"90th_percentile":8879.52,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis With Cc/Mcc","code_information":[{"code":"075","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10968.66,"maximum":59394.56,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":48455.23},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":48455.23},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":38904.16},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37849.53},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14624.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14624.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10968.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59394.56},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37421.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":15514.43,"10th_percentile":15514.43,"90th_percentile":15514.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Mcc","code_information":[{"code":"031","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25364.54,"maximum":138783.49,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":113222.24},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":113222.24},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":90904.86},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":88440.59},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33819.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33819.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25364.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":138783.49},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":87439.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","code_information":[{"code":"023","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32384.42,"maximum":177496.04,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":144804.68},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":144804.68},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":116262.06},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":113110.39},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43179.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43179.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32384.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":177496.04},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":111830.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":144167.88,"10th_percentile":144167.88,"90th_percentile":232826.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":115750.77,"10th_percentile":115750.77,"90th_percentile":115750.77,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41950.1,"10th_percentile":41937.55,"90th_percentile":100546.54,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":85006.88,"10th_percentile":85006.88,"90th_percentile":85006.88},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":21436.9,"10th_percentile":21436.9,"90th_percentile":21436.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40666.38,"10th_percentile":40666.38,"90th_percentile":40666.38,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":32757.33,"10th_percentile":32757.33,"90th_percentile":32757.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":73107.34,"10th_percentile":73107.34,"90th_percentile":73107.34},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allogeneic Bone Marrow Transplant","code_information":[{"code":"014","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":67700.66,"maximum":372254.45,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":303692.33},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":303692.33},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":243831.17},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":237221.33},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90267.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90267.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67700.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":372254.45},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":234536.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant With Mcc Or Intestinal Transplant","code_information":[{"code":"005","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":58110.52,"maximum":319367.74,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":260546.34},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":260546.34},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":209189.73},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":203518.96},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77480.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77480.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58110.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":319367.74},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":201215.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","code_information":[{"code":"415","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11806.69,"maximum":64016.03,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":52225.51},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":52225.51},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":41931.28},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40794.59},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15742.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15742.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11806.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64016.03},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40332.89}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13003.46,"10th_percentile":13003.46,"90th_percentile":13003.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","code_information":[{"code":"423","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23525.03,"maximum":128639.18,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":104946.31},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":104946.31},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":84260.22},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":81976.07},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31366.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31366.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23525.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":128639.18},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":81048.29}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Mcc","code_information":[{"code":"432","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11253.44,"maximum":60965.0,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":49736.41},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":49736.41},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":39932.81},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38850.3},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15004.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15004.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11253.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60965.0},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38410.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":53672.91,"10th_percentile":53672.91,"90th_percentile":53672.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":36301.35,"10th_percentile":36301.35,"90th_percentile":36301.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":39213.37,"10th_percentile":39213.37,"90th_percentile":59536.18,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8462.8,"10th_percentile":8462.8,"90th_percentile":8650.05,"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":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9023.39,"10th_percentile":8650.05,"90th_percentile":40282.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14508.36,"10th_percentile":14274.61,"90th_percentile":16291.91,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":48903.88,"10th_percentile":48903.88,"90th_percentile":48903.88},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":22840.19,"10th_percentile":22840.19,"90th_percentile":22840.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3688.72,"maximum":19247.87,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15702.78},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15702.78},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12607.58},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12265.81},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4918.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4918.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3688.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19247.87},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12126.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":13200.4,"10th_percentile":13200.4,"90th_percentile":13200.4,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5090.33,"10th_percentile":5090.33,"90th_percentile":5090.33,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4241.94,"10th_percentile":4241.94,"90th_percentile":4241.94,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4127.18,"10th_percentile":4127.18,"90th_percentile":4127.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"448","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24018.2,"maximum":131358.78,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":107165.02},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":107165.02},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":86041.59},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":83709.15},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32024.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32024.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24018.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":131358.78},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82761.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":88897.49,"10th_percentile":88897.49,"90th_percentile":88897.49,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30059.4,"10th_percentile":30049.88,"90th_percentile":30317.19,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":117108.95,"10th_percentile":117108.95,"90th_percentile":117108.95},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":75171.44,"10th_percentile":75171.44,"90th_percentile":75171.44,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement Or Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With","code_information":[{"code":"463","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32211.43,"maximum":176542.01,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":144026.37},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":144026.37},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":115637.16},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":112502.43},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42948.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42948.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32211.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":176542.01},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":111229.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39653.44,"10th_percentile":39653.44,"90th_percentile":39693.33,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Mcc","code_information":[{"code":"471","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27320.31,"maximum":149568.98,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":122021.25},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":122021.25},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":97969.49},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":95313.71},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36427.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36427.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27320.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":149568.98},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":94234.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"479","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10639.52,"maximum":57579.43,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":46974.4},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":46974.4},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":37715.22},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36692.83},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14186.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14186.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10639.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57579.43},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36277.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","code_information":[{"code":"488","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10134.01,"maximum":54791.68,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":44700.1},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":44700.1},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":35889.21},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34916.32},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13512.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13512.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10134.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54791.68},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34521.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":21201.96,"10th_percentile":21201.96,"90th_percentile":21201.96,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14560.0,"10th_percentile":14560.0,"90th_percentile":14560.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"1 through 10","median_amount":104999.23,"10th_percentile":104999.23,"90th_percentile":104999.23,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","code_information":[{"code":"498","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17143.22,"maximum":93445.38,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":76234.54},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":76234.54},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":61207.86},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59548.62},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22857.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22857.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17143.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93445.38},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58874.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"1 through 10","median_amount":50089.12,"10th_percentile":50089.12,"90th_percentile":50089.12,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Thumb Or Joint Procedures","code_information":[{"code":"506","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7776.63,"maximum":41791.47,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":34094.28},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":34094.28},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":27373.92},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26631.86},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10368.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10368.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7776.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41791.47},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26330.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","code_information":[{"code":"515","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18098.64,"maximum":98714.23,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":80532.96},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":80532.96},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":64659.01},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62906.22},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24131.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24131.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18098.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98714.23},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62194.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur With Mcc","code_information":[{"code":"533","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9003.91,"maximum":48559.51,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":39615.78},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39615.78},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31807.07},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30944.83},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12005.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12005.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9003.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48559.51},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30594.61}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis Without Cc/Mcc","code_information":[{"code":"541","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4621.11,"maximum":24389.72,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19897.6},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19897.6},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15975.56},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15542.49},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6161.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6161.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4621.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24389.72},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15366.58}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5887.03,"10th_percentile":5887.03,"90th_percentile":5887.03,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders Without Mcc","code_information":[{"code":"607","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5289.51,"maximum":28075.74,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22904.73},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22904.73},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18389.95},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17891.43},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7052.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7052.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5289.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28075.74},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17688.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5006.94,"10th_percentile":5006.94,"90th_percentile":5006.94,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6517.75,"10th_percentile":6517.75,"90th_percentile":6517.75,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5243.67,"10th_percentile":5243.67,"90th_percentile":5243.67,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity Without Cc/Mcc","code_information":[{"code":"621","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8670.82,"maximum":46722.69,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":38117.27},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":38117.27},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30603.93},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29774.31},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11561.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11561.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8670.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46722.69},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29437.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":38486.83,"10th_percentile":38486.83,"90th_percentile":46790.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":29358.46,"10th_percentile":29358.46,"90th_percentile":29658.46,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"12","median_amount":9199.85,"10th_percentile":9199.85,"90th_percentile":9199.85,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10874.85,"10th_percentile":10874.85,"90th_percentile":10874.85,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9199.85,"10th_percentile":9199.85,"90th_percentile":9199.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"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":9689.74,"10th_percentile":9689.74,"90th_percentile":9689.74,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":39011.29,"10th_percentile":39011.29,"90th_percentile":39011.29,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","code_information":[{"code":"629","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12436.34,"maximum":67488.33,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":55058.28},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":55058.28},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":44205.67},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43007.33},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16581.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16581.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12436.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67488.33},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42520.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":39350.38,"10th_percentile":39350.38,"90th_percentile":39350.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7377.52,"10th_percentile":7377.52,"90th_percentile":7377.52,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16247.58,"10th_percentile":16247.58,"90th_percentile":16247.58,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":13013.14,"10th_percentile":13013.14,"90th_percentile":13013.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","code_information":[{"code":"803","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10639.52,"maximum":57579.43,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":46974.4},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":46974.4},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":37715.22},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36692.83},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14186.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14186.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10639.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57579.43},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36277.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders With Mcc","code_information":[{"code":"811","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8086.12,"maximum":43498.19,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35486.66},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35486.66},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28491.84},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27719.48},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10781.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10781.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8086.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43498.19},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27405.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":28682.35,"10th_percentile":28682.35,"90th_percentile":28682.35,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9480.93,"10th_percentile":9480.93,"90th_percentile":9480.93,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10476.75,"10th_percentile":10473.13,"90th_percentile":10578.19,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":9593.69,"10th_percentile":9593.69,"90th_percentile":9593.69,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9017.32,"10th_percentile":9017.32,"90th_percentile":9481.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"819","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5028.33,"maximum":26635.4,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21729.67},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21729.67},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17446.51},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16973.57},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6704.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6704.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5028.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26635.4},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16781.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Mcc","code_information":[{"code":"643","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9444.26,"maximum":50987.95,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":41596.95},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":41596.95},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33397.72},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32492.37},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12592.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12592.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9444.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50987.95},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32124.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8488.22,"10th_percentile":8488.22,"90th_percentile":8488.22,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10919.76,"10th_percentile":10919.76,"90th_percentile":10919.76,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8775.11,"10th_percentile":8775.11,"90th_percentile":8775.11,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12338.54,"10th_percentile":12338.54,"90th_percentile":12338.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures Without Cc/Mcc","code_information":[{"code":"655","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12086.97,"maximum":65561.69,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":53486.48},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":53486.48},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":42943.7},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41779.57},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16115.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16115.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12086.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65561.69},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41306.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15470.44,"10th_percentile":15470.44,"90th_percentile":15470.44,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Cc","code_information":[{"code":"663","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8737.1,"maximum":47088.2,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":38415.45},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":38415.45},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30843.34},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30007.23},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11649.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11649.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8737.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47088.2},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29667.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10724.17,"10th_percentile":10724.17,"90th_percentile":11336.62,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures With Cc/Mcc","code_information":[{"code":"671","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10280.6,"maximum":55600.13,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":45359.65},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":45359.65},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36418.76},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35431.51},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13707.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13707.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10280.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55600.13},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35030.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":26548.38,"10th_percentile":26548.38,"90th_percentile":26548.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":46184.05,"10th_percentile":46184.05,"90th_percentile":46184.05,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Mcc","code_information":[{"code":"686","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10329.47,"maximum":55869.61,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":45579.5},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":45579.5},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36595.27},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35603.23},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13772.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13772.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10329.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55869.61},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35200.29}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":44854.97,"10th_percentile":44854.97,"90th_percentile":44854.97,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms Without Mcc","code_information":[{"code":"696","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4068.41,"maximum":21341.78,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17411.03},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17411.03},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13979.12},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13600.17},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5424.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5424.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4068.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21341.78},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13446.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4341.93,"10th_percentile":4341.93,"90th_percentile":4341.93,"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":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5233.3,"10th_percentile":5233.3,"90th_percentile":5233.3,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures Without Cc/Mcc","code_information":[{"code":"710","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8068.7,"maximum":43402.17,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35408.32},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35408.32},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28428.95},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27658.29},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10758.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10758.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8068.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43402.17},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27345.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Mcc","code_information":[{"code":"548","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11043.93,"maximum":59809.63,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":48793.84},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":48793.84},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":39176.03},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38114.04},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14725.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14725.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11043.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59809.63},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37682.67}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","code_information":[{"code":"556","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4863.76,"maximum":25727.84,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20989.26},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20989.26},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16852.04},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16395.21},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6485.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6485.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4863.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25727.84},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16209.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6361.32,"10th_percentile":6361.32,"90th_percentile":6361.32,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures Without Cc/Mcc","code_information":[{"code":"712","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6375.24,"maximum":34063.21,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27789.42},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27789.42},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22311.81},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21706.98},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8500.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8500.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6375.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34063.21},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21461.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Cc","code_information":[{"code":"723","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6616.76,"maximum":35395.13,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28876.03},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28876.03},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23184.24},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22555.76},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8822.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8822.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6616.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35395.13},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22300.48}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","code_information":[{"code":"734","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12162.23,"maximum":65976.75,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":53825.1},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":53825.1},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":43215.57},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42044.07},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16216.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16216.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12162.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65976.75},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41568.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","code_information":[{"code":"742","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10504.16,"maximum":56832.93,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":46365.4},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":46365.4},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":37226.26},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36217.12},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14005.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14005.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10504.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56832.93},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35807.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":10014.19,"10th_percentile":10014.19,"90th_percentile":10014.19,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement Without Cc/Mcc","code_information":[{"code":"572","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6636.98,"maximum":35506.64,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28967.0},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28967.0},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23257.28},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22626.82},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8849.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8849.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6636.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35506.64},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22370.73}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4906.38,"10th_percentile":4906.38,"90th_percentile":4906.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","code_information":[{"code":"580","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9904.28,"maximum":53524.8,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":43666.56},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":43666.56},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":35059.39},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34108.99},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13205.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13205.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9904.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53524.8},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33722.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":33084.94,"10th_percentile":33084.94,"90th_percentile":33084.94,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":17969.38,"10th_percentile":17969.38,"90th_percentile":17969.38,"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":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":17791.47,"10th_percentile":17791.47,"90th_percentile":17791.47,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12794.94,"10th_percentile":12794.94,"90th_percentile":12794.94,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers Without Cc/Mcc","code_information":[{"code":"594","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5067.08,"maximum":26849.13,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21904.04},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21904.04},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17586.51},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17109.77},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6756.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6756.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5067.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26849.13},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16916.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","code_information":[{"code":"747","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5027.2,"maximum":26629.21,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21724.62},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21724.62},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17442.45},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16969.62},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6702.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6702.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5027.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26629.21},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16777.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Cc","code_information":[{"code":"758","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5697.29,"maximum":30324.53,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24739.33},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24739.33},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19862.93},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19324.48},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7596.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7596.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5697.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30324.53},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19105.77}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5287.13,"10th_percentile":5287.13,"90th_percentile":5287.13,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion Without D&C","code_information":[{"code":"779","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4923.86,"maximum":26059.27,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21259.65},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21259.65},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17069.14},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16606.42},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6565.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6565.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4923.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26059.27},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16418.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3572.04,"10th_percentile":3572.04,"90th_percentile":3572.04,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","code_information":[{"code":"790","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33581.93,"maximum":184099.91,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":150192.25},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":150192.25},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":120587.67},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":117318.75},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44775.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44775.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33581.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":184099.91},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":115990.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":90028.93,"10th_percentile":22398.1,"90th_percentile":253512.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"15","median_amount":52200.0,"10th_percentile":17035.48,"90th_percentile":561150.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":88553.07,"10th_percentile":88553.07,"90th_percentile":88553.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"21","median_amount":18005.6,"10th_percentile":15395.59,"90th_percentile":79075.99,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":15395.59,"10th_percentile":15395.59,"90th_percentile":15395.59,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":109941.2,"10th_percentile":109941.2,"90th_percentile":109941.2},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7276.57,"10th_percentile":7276.57,"90th_percentile":7276.57,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":22937.77,"10th_percentile":22937.77,"90th_percentile":22937.77},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":116697.28,"10th_percentile":116697.28,"90th_percentile":287650.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":437935.26,"10th_percentile":437935.26,"90th_percentile":437935.26,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","code_information":[{"code":"798","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5574.28,"maximum":29646.17,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24185.92},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24185.92},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19418.6},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18892.2},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7432.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7432.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5574.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29646.17},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18678.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":11286.0,"10th_percentile":11286.0,"90th_percentile":11286.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","code_information":[{"code":"830","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8651.73,"maximum":46617.38,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":38031.35},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":38031.35},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30534.95},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29707.2},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11535.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11535.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8651.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46617.38},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29370.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","code_information":[{"code":"838","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11922.96,"maximum":64657.22,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":52748.6},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":52748.6},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":42351.26},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41203.19},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15897.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15897.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11922.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64657.22},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40736.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","code_information":[{"code":"846","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14760.01,"maximum":80302.69,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":65512.48},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":65512.48},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":52599.23},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51173.36},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19680.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19680.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14760.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80302.69},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50594.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":12388.53,"10th_percentile":12388.53,"90th_percentile":12388.53,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","code_information":[{"code":"856","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25747.6,"maximum":140895.98,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":114945.65},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":114945.65},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":92288.57},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":89786.79},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34330.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34330.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25747.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":140895.98},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":88770.61}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":19912.83,"10th_percentile":19912.83,"90th_percentile":19912.83,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":53981.98,"10th_percentile":53981.98,"90th_percentile":53981.98,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":19912.83,"10th_percentile":19912.83,"90th_percentile":19912.83,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21390.49,"10th_percentile":21390.49,"90th_percentile":21390.49,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":210782.14,"10th_percentile":210782.14,"90th_percentile":210782.14},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Mcc","code_information":[{"code":"867","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11955.53,"maximum":64836.87,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":52895.16},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":52895.16},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":42468.93},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41317.67},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15940.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15940.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11955.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64836.87},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40850.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":43505.7,"10th_percentile":43505.7,"90th_percentile":43505.7,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14898.02,"10th_percentile":14898.02,"90th_percentile":14898.02,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Depressive Neuroses","code_information":[{"code":"881","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5483.29,"maximum":29144.38,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23776.54},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23776.54},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19089.92},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18572.43},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7311.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7311.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5483.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29144.38},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18362.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":11394.01,"10th_percentile":11394.01,"90th_percentile":11394.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":16463.65,"10th_percentile":16463.65,"90th_percentile":17933.5,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4640.6,"10th_percentile":4640.6,"90th_percentile":4640.6,"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":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5615.65,"10th_percentile":5615.65,"90th_percentile":5615.65,"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":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"22","median_amount":4640.6,"10th_percentile":4613.46,"90th_percentile":6526.64,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3467.79,"10th_percentile":3467.79,"90th_percentile":3467.79,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4640.6,"10th_percentile":4640.6,"90th_percentile":4640.6,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6526.64,"10th_percentile":6526.64,"90th_percentile":6526.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4640.6,"10th_percentile":4640.6,"90th_percentile":4640.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","code_information":[{"code":"895","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8149.59,"maximum":43848.21,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35772.21},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35772.21},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28721.11},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27942.53},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10866.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10866.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8149.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43848.21},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27626.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":12079.34,"10th_percentile":12079.34,"90th_percentile":12079.34,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Procedures For Injuries","code_information":[{"code":"906","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11231.53,"maximum":60844.19,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":49637.86},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":49637.86},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":39853.68},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38773.32},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14975.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14975.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11231.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60844.19},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38334.49}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs With Mcc","code_information":[{"code":"917","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9007.84,"maximum":48581.19,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":39633.47},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39633.47},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31821.27},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30958.65},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12010.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12010.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9007.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48581.19},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30608.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":26345.9,"10th_percentile":26345.9,"90th_percentile":26345.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":23264.6,"10th_percentile":23264.6,"90th_percentile":33267.87,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4007.7,"10th_percentile":4007.7,"90th_percentile":7123.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12191.04,"10th_percentile":12163.04,"90th_percentile":12315.19,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":13386.35,"10th_percentile":13386.35,"90th_percentile":13386.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6714.5,"10th_percentile":6714.5,"90th_percentile":6714.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12163.04,"10th_percentile":12163.04,"90th_percentile":12163.04,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6307.7,"10th_percentile":6307.7,"90th_percentile":6307.7,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":44263.14,"10th_percentile":44263.14,"90th_percentile":44263.14},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","code_information":[{"code":"928","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40486.11,"maximum":222174.38,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":181254.13},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":181254.13},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":145526.91},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":141581.93},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53981.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53981.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40486.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":222174.38},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":139979.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Without Mcc","code_information":[{"code":"948","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4694.69,"maximum":24795.49,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20228.64},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20228.64},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16241.34},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15801.07},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6259.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6259.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4694.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24795.49},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15622.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":9494.1,"10th_percentile":9494.1,"90th_percentile":9494.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":12149.55,"10th_percentile":12149.55,"90th_percentile":12149.55,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7457.58,"10th_percentile":7457.58,"90th_percentile":7457.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6056.0,"10th_percentile":5641.82,"90th_percentile":6133.44,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3948.02,"10th_percentile":3948.02,"90th_percentile":5978.39,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":24609.64,"10th_percentile":24609.64,"90th_percentile":24609.64,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"959","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16734.88,"maximum":91193.5,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":74397.41},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":74397.41},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":59732.84},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58113.59},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22313.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22313.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16734.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91193.5},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57455.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition Without Cc/Mcc","code_information":[{"code":"976","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5268.73,"maximum":27961.13,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22811.23},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22811.23},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18314.88},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17818.4},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7024.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7024.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5268.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27961.13},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17616.73}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures With Cc/Mcc","code_information":[{"code":"711","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11902.74,"maximum":64545.71,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":52657.63},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":52657.63},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":42278.22},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41132.13},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15870.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15870.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11902.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64545.71},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40666.61}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":16752.27,"10th_percentile":16752.27,"90th_percentile":16752.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Cc","code_information":[{"code":"549","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6979.04,"maximum":37393.02,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30505.94},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30505.94},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24492.88},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23828.92},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9305.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9305.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6979.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37393.02},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23559.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis With Mcc","code_information":[{"code":"557","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8550.07,"maximum":46056.73,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":37573.96},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37573.96},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30167.71},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29349.92},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11400.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11400.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8550.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46056.73},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29017.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8296.49,"10th_percentile":8296.49,"90th_percentile":8296.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy With Cc/Mcc","code_information":[{"code":"713","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8642.74,"maximum":46567.82,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":37990.92},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37990.92},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30502.48},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29675.61},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11523.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11523.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8642.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46567.82},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29339.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10759.24,"10th_percentile":10759.24,"90th_percentile":11088.84,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":10785.76,"10th_percentile":10785.76,"90th_percentile":10785.76,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System Without Cc/Mcc","code_information":[{"code":"724","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3881.38,"maximum":20310.31,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16569.54},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16569.54},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13303.5},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12942.86},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5175.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5175.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3881.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20310.31},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12796.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","code_information":[{"code":"735","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7755.85,"maximum":41676.86,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":34000.79},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":34000.79},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":27298.85},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26558.82},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10341.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10341.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7755.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41676.86},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26258.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","code_information":[{"code":"743","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7167.21,"maximum":38430.68,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":31352.49},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31352.49},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25172.56},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24490.18},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9556.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9556.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7167.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38430.68},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24213.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":17633.11,"10th_percentile":17633.11,"90th_percentile":17633.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8062.92,"10th_percentile":8062.92,"90th_percentile":8062.92,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":31797.42,"10th_percentile":31797.42,"90th_percentile":31797.42},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"573","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36996.39,"maximum":202929.62,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":165553.88},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":165553.88},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":132921.35},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":129318.08},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49328.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49328.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36996.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":202929.62},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":127854.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","code_information":[{"code":"581","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8304.05,"maximum":44700.02,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":36467.14},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":36467.14},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29279.06},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28485.35},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11072.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11072.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8304.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44700.02},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28162.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":36368.58,"10th_percentile":36368.58,"90th_percentile":36368.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders With Mcc","code_information":[{"code":"595","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12110.0,"maximum":65688.68,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":53590.09},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":53590.09},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":43026.88},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41860.5},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16146.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16146.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12110.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65688.68},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41386.73}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Female Reproductive System Reconstructive Procedures","code_information":[{"code":"748","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7990.64,"maximum":42971.62,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35057.07},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35057.07},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28146.93},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27383.91},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10654.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10654.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7990.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42971.62},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27073.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"759","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3925.75,"maximum":20555.01,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16769.17},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16769.17},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13463.78},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13098.8},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5234.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5234.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3925.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20555.01},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12950.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4173.23,"10th_percentile":4173.23,"90th_percentile":5287.13,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":7676.04,"10th_percentile":7676.04,"90th_percentile":7676.04,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Mcc","code_information":[{"code":"783","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13988.26,"maximum":76046.72,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":62040.38},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":62040.38},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":49811.52},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48461.22},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18651.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18651.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13988.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76046.72},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47912.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":22805.0,"10th_percentile":22805.0,"90th_percentile":22805.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":24569.0,"10th_percentile":24569.0,"90th_percentile":24569.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8444.08,"10th_percentile":8444.08,"90th_percentile":8444.08,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity With Major Problems","code_information":[{"code":"791","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22997.06,"maximum":125727.53,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":102570.93},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":102570.93},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":82353.05},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":80120.6},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30662.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30662.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22997.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":125727.53},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":79213.82}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":84492.12,"10th_percentile":84492.12,"90th_percentile":84492.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":52200.0,"10th_percentile":13050.0,"90th_percentile":182486.69,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9872.87,"10th_percentile":9872.87,"90th_percentile":9872.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":11427.0,"10th_percentile":5143.73,"90th_percentile":47025.18,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":13666.03,"10th_percentile":13666.03,"90th_percentile":13666.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7842.94,"10th_percentile":7842.94,"90th_percentile":7842.94,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":15473.12,"10th_percentile":15473.12,"90th_percentile":15473.12,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":29029.38,"10th_percentile":29029.38,"90th_percentile":29029.38,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","code_information":[{"code":"823","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25950.38,"maximum":142014.18,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":115857.9},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":115857.9},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":93021.01},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":90499.37},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34600.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34600.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25950.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":142014.18},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":89475.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32531.06,"10th_percentile":32531.06,"90th_percentile":32531.06,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","code_information":[{"code":"831","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6952.64,"maximum":37247.44,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30387.18},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30387.18},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24397.52},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23736.15},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9270.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9270.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6952.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37247.44},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23467.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4627.4,"10th_percentile":4627.4,"90th_percentile":4866.56,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"839","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8308.54,"maximum":44724.8,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":36487.35},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":36487.35},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29295.29},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28501.14},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11078.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11078.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8308.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44724.8},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28178.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":23903.5,"10th_percentile":23903.5,"90th_percentile":23903.5,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","code_information":[{"code":"847","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7546.34,"maximum":40521.5,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33058.21},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33058.21},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26542.07},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25822.56},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10061.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10061.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7546.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40521.5},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25530.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":25781.23,"10th_percentile":25781.23,"90th_percentile":25781.23,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7655.48,"10th_percentile":7655.48,"90th_percentile":7655.48,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9464.35,"10th_percentile":9464.35,"90th_percentile":9496.31,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":18184.29,"10th_percentile":18184.29,"90th_percentile":18184.29,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","code_information":[{"code":"857","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12226.83,"maximum":66332.96,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":54115.71},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":54115.71},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":43448.89},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42271.07},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16302.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16302.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12226.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66332.96},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41792.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14057.3,"10th_percentile":14057.3,"90th_percentile":14057.3,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"1 through 10","median_amount":32309.15,"10th_percentile":32309.15,"90th_percentile":32309.15,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Cc","code_information":[{"code":"868","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5989.93,"maximum":31938.32,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26055.9},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26055.9},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20919.99},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20352.88},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7986.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7986.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5989.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31938.32},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20122.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":67820.33,"10th_percentile":67820.33,"90th_percentile":67820.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":22428.34,"10th_percentile":22428.34,"90th_percentile":22428.34,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":32731.04,"10th_percentile":32731.04,"90th_percentile":32731.04,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neuroses Except Depressive","code_information":[{"code":"882","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6229.76,"maximum":33260.96,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27134.93},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27134.93},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21786.33},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21195.74},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8306.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8306.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6229.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33260.96},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20955.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":5089.95,"10th_percentile":5089.95,"90th_percentile":13981.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":4761.32,"10th_percentile":4241.25,"90th_percentile":19106.79,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6698.1,"10th_percentile":6698.1,"90th_percentile":6698.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6512.18,"10th_percentile":6512.18,"90th_percentile":6512.18,"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":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"11","median_amount":4466.33,"10th_percentile":4338.89,"90th_percentile":6698.1,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4466.33,"10th_percentile":4466.33,"90th_percentile":6447.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6513.76,"10th_percentile":6513.76,"90th_percentile":6698.1,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6698.1,"10th_percentile":6698.1,"90th_percentile":6698.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2481.3,"10th_percentile":2481.3,"90th_percentile":2481.3,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":4549.74,"10th_percentile":4549.74,"90th_percentile":4549.74,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","code_information":[{"code":"896","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10000.33,"maximum":54054.47,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":44098.68},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":44098.68},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":35406.33},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34446.53},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13333.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13333.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10000.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54054.47},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34056.67}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":44845.5,"10th_percentile":44845.5,"90th_percentile":44845.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":30685.4,"10th_percentile":10691.4,"90th_percentile":49322.65,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":33352.75,"10th_percentile":33352.75,"90th_percentile":33352.75,"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":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"13","median_amount":14191.64,"10th_percentile":7885.65,"90th_percentile":14191.64,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12628.59,"10th_percentile":12628.59,"90th_percentile":12628.59,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":29090.2,"10th_percentile":29090.2,"90th_percentile":29090.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6853.64,"10th_percentile":6853.64,"90th_percentile":6853.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15890.73,"10th_percentile":15890.73,"90th_percentile":15890.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":17731.41,"10th_percentile":17731.41,"90th_percentile":17731.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":11211.46,"10th_percentile":11211.46,"90th_percentile":11211.46},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Mcc","code_information":[{"code":"907","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21763.04,"maximum":118922.32,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":97019.11},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":97019.11},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":77895.56},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75783.94},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29017.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29017.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21763.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":118922.32},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74926.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":197383.44,"10th_percentile":197383.44,"90th_percentile":197383.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29306.01,"10th_percentile":29306.01,"90th_percentile":38472.37,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":29505.76,"10th_percentile":29505.76,"90th_percentile":29505.76,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":86676.23,"10th_percentile":86676.23,"90th_percentile":86676.23,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs Without Mcc","code_information":[{"code":"918","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5012.6,"maximum":26548.67,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21658.92},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21658.92},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17389.7},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16918.3},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6683.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6683.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5012.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26548.67},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16726.82}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":22353.84,"10th_percentile":22353.84,"90th_percentile":22353.84,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4100.62,"10th_percentile":4100.62,"90th_percentile":4100.62,"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":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"14","median_amount":4100.62,"10th_percentile":3120.75,"90th_percentile":4100.62,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6944.23,"10th_percentile":6944.23,"90th_percentile":12748.15,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6227.66,"10th_percentile":6227.66,"90th_percentile":6227.66,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4100.62,"10th_percentile":4100.62,"90th_percentile":4100.62,"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":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6640.58,"10th_percentile":6640.58,"90th_percentile":6640.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":12610.74,"10th_percentile":12610.74,"90th_percentile":12610.74},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3120.75,"10th_percentile":3120.75,"90th_percentile":3120.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":9299.48,"10th_percentile":9299.48,"90th_percentile":10994.51},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":18741.29,"10th_percentile":18741.29,"90th_percentile":18741.29,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","code_information":[{"code":"929","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18289.05,"maximum":99764.28,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":81389.62},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":81389.62},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":65346.81},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63575.37},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24385.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24385.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18289.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99764.28},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62855.84}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare With Cc/Mcc","code_information":[{"code":"949","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6880.75,"maximum":36850.96,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30063.72},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30063.72},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24137.82},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23483.49},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9174.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9174.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6880.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36850.96},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23217.71}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Mcc","code_information":[{"code":"963","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15553.66,"maximum":84679.46,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":69083.13},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":69083.13},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":55466.07},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53962.48},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20738.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20738.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15553.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84679.46},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53351.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17981.74,"10th_percentile":17981.74,"90th_percentile":17981.74,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Or Without Other Related Condition","code_information":[{"code":"977","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7487.36,"maximum":40196.26,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":32792.88},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":32792.88},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26329.04},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25615.3},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9983.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9983.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7487.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40196.26},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25325.39}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","code_information":[{"code":"096","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14685.31,"maximum":79890.72,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":65176.38},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":65176.38},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":52329.39},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50910.83},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19580.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19580.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14685.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79890.72},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50334.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Mcc","code_information":[{"code":"088","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7791.23,"maximum":41872.01,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":34159.99},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":34159.99},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":27426.67},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26683.18},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10388.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10388.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7791.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41872.01},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26381.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma With Mcc","code_information":[{"code":"080","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10364.86,"maximum":56064.75,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":45738.7},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":45738.7},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36723.09},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35727.59},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13819.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13819.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10364.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56064.75},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35323.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures Without Cc/Mcc","code_information":[{"code":"033","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9538.63,"maximum":51508.33,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":42021.48},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":42021.48},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33738.58},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32823.98},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12718.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12718.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9538.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51508.33},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32452.49}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12861.83,"10th_percentile":12861.83,"90th_percentile":12861.83,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Mcc","code_information":[{"code":"025","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25736.37,"maximum":140834.03,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":114895.11},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":114895.11},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":92248.0},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":89747.31},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34315.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34315.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25736.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":140834.03},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":88731.58}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":91528.0,"10th_percentile":91528.0,"90th_percentile":91528.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":96585.55,"10th_percentile":96585.55,"90th_percentile":260780.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":50283.49,"10th_percentile":50283.49,"90th_percentile":50283.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32918.49,"10th_percentile":32309.94,"90th_percentile":33623.47,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":32897.49,"10th_percentile":32897.49,"90th_percentile":32897.49,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":144739.83,"10th_percentile":144739.83,"90th_percentile":144739.83},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":107113.36,"10th_percentile":107113.36,"90th_percentile":107113.36,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant Without Cc/Mcc","code_information":[{"code":"017","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30710.62,"maximum":168265.49,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":137274.22},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":137274.22},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":110215.93},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":107228.17},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40947.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40947.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30710.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":168265.49},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":106014.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lung Transplant","code_information":[{"code":"007","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":72937.22,"maximum":401132.45,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":327251.55},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":327251.55},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":262746.61},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":255624.0},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97249.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97249.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72937.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":401132.45},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":252730.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. Without Cc/Mcc","code_information":[{"code":"413","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9525.14,"maximum":51433.99,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":41960.84},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":41960.84},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33689.88},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32776.61},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12700.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12700.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9525.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51433.99},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32405.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Cc","code_information":[{"code":"421","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9957.64,"maximum":53819.06,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":43906.63},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":43906.63},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":35252.14},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34296.51},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13276.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13276.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9957.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53819.06},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33908.36}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","code_information":[{"code":"429","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50803.62,"maximum":279072.36,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":227672.59},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":227672.59},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":182795.77},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":177840.49},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67738.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67738.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50803.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":279072.36},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":175827.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Mcc","code_information":[{"code":"438","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9354.95,"maximum":50495.45,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":41195.15},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":41195.15},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33075.13},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32178.52},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12473.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12473.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9354.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50495.45},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31814.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":33098.82,"10th_percentile":33098.82,"90th_percentile":33098.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":21083.48,"10th_percentile":9201.41,"90th_percentile":39328.92,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12450.32,"10th_percentile":12450.32,"90th_percentile":12450.32,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9201.41,"10th_percentile":9201.41,"90th_percentile":9201.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9201.41,"10th_percentile":9201.41,"90th_percentile":9201.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":15893.44,"10th_percentile":15893.44,"90th_percentile":15893.44,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":22950.51,"10th_percentile":22950.51,"90th_percentile":22950.51,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract Without Cc/Mcc","code_information":[{"code":"446","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4845.22,"maximum":25625.62,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20905.87},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20905.87},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16785.09},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16330.07},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6460.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6460.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4845.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25625.62},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16145.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":59551.77,"10th_percentile":59551.77,"90th_percentile":59551.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":16176.42,"10th_percentile":16176.42,"90th_percentile":16176.42,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5490.01,"10th_percentile":5490.01,"90th_percentile":5490.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6033.33,"10th_percentile":6033.33,"90th_percentile":6351.1,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":25775.75,"10th_percentile":25775.75,"90th_percentile":25775.75},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":28577.73,"10th_percentile":28577.73,"90th_percentile":28577.73,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","code_information":[{"code":"461","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31220.06,"maximum":171074.93,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":139566.21},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":139566.21},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":112056.15},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":109018.5},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41626.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41626.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31220.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":171074.93},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":107784.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","code_information":[{"code":"469","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17235.34,"maximum":93953.37,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":76648.96},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":76648.96},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":61540.59},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59872.33},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22980.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22980.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17235.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93953.37},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59194.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24111.03,"10th_percentile":24111.03,"90th_percentile":24111.03,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc Or Insertion Of Antibiotic-Eluting","code_information":[{"code":"477","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19602.26,"maximum":107006.24,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":87297.74},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":87297.74},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":70090.38},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68190.35},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26136.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26136.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19602.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107006.24},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67418.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24332.73,"10th_percentile":24332.73,"90th_percentile":24332.73,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Cc","code_information":[{"code":"486","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11943.74,"maximum":64771.82,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":52842.1},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":52842.1},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":42426.33},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41276.22},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15924.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15924.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11943.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64771.82},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40809.07}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15845.79,"10th_percentile":15845.79,"90th_percentile":15845.79,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","code_information":[{"code":"496","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10330.59,"maximum":55875.8,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":45584.55},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":45584.55},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36599.33},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35607.18},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13774.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13774.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55875.8},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35204.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":12745.34,"10th_percentile":12745.34,"90th_percentile":12745.34,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Cc","code_information":[{"code":"504","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10697.37,"maximum":57898.47,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":47234.68},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":47234.68},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":37924.2},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36896.14},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14263.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14263.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10697.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57898.47},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36478.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":12811.31,"10th_percentile":12811.31,"90th_percentile":12811.31,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13249.38,"10th_percentile":13249.38,"90th_percentile":13249.38,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"1 through 10","median_amount":87795.48,"10th_percentile":87795.48,"90th_percentile":87795.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","code_information":[{"code":"513","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9040.97,"maximum":48763.94,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":39782.56},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39782.56},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31940.97},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31075.11},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12054.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12054.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9040.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48763.94},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30723.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":30098.57,"10th_percentile":30098.57,"90th_percentile":30098.57,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9959.54,"10th_percentile":9959.54,"90th_percentile":9959.54,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":61113.0,"10th_percentile":61113.0,"90th_percentile":61113.0},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"1 through 10","median_amount":77629.1,"10th_percentile":77629.1,"90th_percentile":77629.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","code_information":[{"code":"521","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16319.8,"maximum":88904.45,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":72529.95},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":72529.95},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":58233.49},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56654.88},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21759.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21759.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16319.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88904.45},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56013.68}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":94345.23,"10th_percentile":94345.23,"90th_percentile":94345.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":21532.24,"10th_percentile":21532.24,"90th_percentile":21532.24,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":59105.26,"10th_percentile":59105.26,"90th_percentile":59105.26},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Mcc","code_information":[{"code":"539","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11261.86,"maximum":61011.46,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":49774.32},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":49774.32},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":39963.24},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38879.91},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15015.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15015.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11261.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61011.46},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38439.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","code_information":[{"code":"605","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5343.43,"maximum":28373.1,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":23147.32},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":23147.32},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18584.72},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18080.92},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7124.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7124.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5343.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28373.1},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17876.29}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5578.62,"10th_percentile":5578.62,"90th_percentile":5578.62,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5901.25,"10th_percentile":5901.25,"90th_percentile":5901.25,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6458.83,"10th_percentile":6458.83,"90th_percentile":6458.83,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":18567.42,"10th_percentile":18567.42,"90th_percentile":18567.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Mcc","code_information":[{"code":"619","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16416.4,"maximum":89437.22,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":72964.6},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":72964.6},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":58582.46},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56994.39},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21888.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21888.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16416.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89437.22},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56349.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","code_information":[{"code":"627","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7659.24,"maximum":41144.09,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33566.14},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33566.14},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26949.88},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26219.31},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10212.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10212.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7659.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41144.09},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25922.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures Without Cc/Mcc","code_information":[{"code":"801","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10920.36,"maximum":59128.18,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":48237.9},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":48237.9},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":38729.67},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37679.78},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14560.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14560.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10920.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59128.18},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37253.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"809","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7308.75,"maximum":39211.25,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":31989.29},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":31989.29},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25683.85},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24987.6},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9745.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9745.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7308.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39211.25},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24704.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6643.6,"10th_percentile":6643.6,"90th_percentile":6643.6,"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":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9268.84,"10th_percentile":9268.84,"90th_percentile":9548.6,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":38362.54,"10th_percentile":38362.54,"90th_percentile":38362.54,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Mcc","code_information":[{"code":"817","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13013.74,"maximum":70672.56,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":57656.03},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":57656.03},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":46291.38},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45036.5},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17351.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17351.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13013.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70672.56},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44526.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":12762.52,"10th_percentile":12762.52,"90th_percentile":12762.52,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","code_information":[{"code":"641","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4569.44,"maximum":24104.75,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19665.11},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19665.11},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15788.9},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15360.89},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6092.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6092.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4569.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24104.75},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15187.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":6226.9,"10th_percentile":6226.9,"90th_percentile":6226.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":15853.82,"10th_percentile":12683.06,"90th_percentile":16531.3,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4606.56,"10th_percentile":4606.56,"90th_percentile":4606.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8291.54,"10th_percentile":5027.55,"90th_percentile":9654.3,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5945.32,"10th_percentile":5938.32,"90th_percentile":6635.95,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":10748.43,"10th_percentile":10748.43,"90th_percentile":10748.43,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4275.95,"10th_percentile":4275.95,"90th_percentile":4275.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":23054.25,"10th_percentile":23054.25,"90th_percentile":23054.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Mcc","code_information":[{"code":"653","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29385.62,"maximum":160958.49,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":131313.03},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":131313.03},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":105429.76},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":102571.74},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39180.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39180.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29385.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":160958.49},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":101410.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","code_information":[{"code":"661","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6014.08,"maximum":32071.52,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26164.56},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26164.56},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21007.23},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20437.76},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8018.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8018.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6014.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32071.52},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20206.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":27128.99,"10th_percentile":27128.99,"90th_percentile":27128.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":20828.69,"10th_percentile":20828.69,"90th_percentile":20828.69,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4124.04,"10th_percentile":4124.04,"90th_percentile":4124.04,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7688.37,"10th_percentile":7405.08,"90th_percentile":7782.17,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":21488.9,"10th_percentile":21488.9,"90th_percentile":21488.9},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Cc","code_information":[{"code":"669","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8915.72,"maximum":48073.2,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":39219.04},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39219.04},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31488.53},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30634.93},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11887.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11887.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8915.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48073.2},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30288.21}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Cc","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5117.63,"maximum":27127.91,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22131.47},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22131.47},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17769.11},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17287.42},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6823.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6823.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5117.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27127.91},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17091.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":22462.5,"10th_percentile":22462.5,"90th_percentile":22462.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":18034.89,"10th_percentile":18034.89,"90th_percentile":24630.89,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5098.45,"10th_percentile":5098.45,"90th_percentile":5098.45,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":6388.74,"10th_percentile":4673.74,"90th_percentile":6703.61,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5098.45,"10th_percentile":5098.45,"90th_percentile":5098.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"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":6675.61,"10th_percentile":6675.61,"90th_percentile":6705.55,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":240.85,"10th_percentile":240.85,"90th_percentile":240.85,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5098.45,"10th_percentile":5098.45,"90th_percentile":5098.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":24193.99,"10th_percentile":24193.99,"90th_percentile":24193.99,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones Without Mcc","code_information":[{"code":"694","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4589.09,"maximum":24213.16,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19753.56},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19753.56},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15859.91},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15429.98},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6118.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6118.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4589.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24213.16},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15255.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5898.24,"10th_percentile":5885.83,"90th_percentile":5899.83,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":5922.49,"10th_percentile":5922.49,"90th_percentile":5922.49,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":22129.89,"10th_percentile":22129.89,"90th_percentile":22129.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures Without Cc/Mcc","code_information":[{"code":"708","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8815.74,"maximum":47521.85,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":38769.23},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":38769.23},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31127.38},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30283.57},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11754.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11754.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8815.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47521.85},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29940.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":32591.01,"10th_percentile":32591.01,"90th_percentile":32591.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Cc","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5706.84,"maximum":30377.18,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24782.29},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24782.29},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19897.42},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19358.04},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7609.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7609.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5706.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30377.18},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19138.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":17202.92,"10th_percentile":17202.92,"90th_percentile":17202.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":20002.93,"10th_percentile":18059.54,"90th_percentile":24913.69,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5573.16,"10th_percentile":5573.16,"90th_percentile":5858.14,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":7104.65,"10th_percentile":6352.42,"90th_percentile":7447.65,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":7381.42,"10th_percentile":7381.42,"90th_percentile":7418.91,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12126.01,"10th_percentile":12126.01,"90th_percentile":12126.01,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":27384.17,"10th_percentile":27384.17,"90th_percentile":27384.17},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":10986.77,"10th_percentile":10986.77,"90th_percentile":10986.77},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":26347.94,"10th_percentile":20720.29,"90th_percentile":30514.11,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","code_information":[{"code":"360","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13759.1,"maximum":74782.94,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":61009.36},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":61009.36},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":48983.73},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47655.87},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18345.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18345.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13759.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74782.94},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47116.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":57022.55,"10th_percentile":57022.55,"90th_percentile":57022.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":67956.68,"10th_percentile":67956.68,"90th_percentile":67956.68,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","code_information":[{"code":"352","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6757.74,"maximum":36172.61,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":29510.31},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29510.31},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23693.49},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23051.2},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9010.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9010.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6757.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36172.61},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22790.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7838.96,"10th_percentile":7838.96,"90th_percentile":7838.96,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Mcc","code_information":[{"code":"344","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14705.53,"maximum":80002.23,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":65267.36},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":65267.36},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":52402.43},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50981.89},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19607.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19607.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14705.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80002.23},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50404.89}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Cc","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13663.04,"maximum":74253.27,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":60577.24},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":60577.24},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":48636.79},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47318.33},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18217.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18217.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13663.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74253.27},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46782.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":59730.7,"10th_percentile":42940.12,"90th_percentile":59730.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":50923.72,"10th_percentile":47957.11,"90th_percentile":80937.11,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":14570.79,"10th_percentile":10311.77,"90th_percentile":14787.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":17502.6,"10th_percentile":15409.6,"90th_percentile":17850.2,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17467.62,"10th_percentile":17467.62,"90th_percentile":17481.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":85866.01,"10th_percentile":85866.01,"90th_percentile":85866.01},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":83861.87,"10th_percentile":83861.87,"90th_percentile":83861.87},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":65525.44,"10th_percentile":53864.46,"90th_percentile":73215.61,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":39131.6,"10th_percentile":39131.6,"90th_percentile":39131.6,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","code_information":[{"code":"322","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10100.86,"maximum":54608.93,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":44551.01},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":44551.01},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":35769.51},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34799.86},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13467.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13467.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10100.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54608.93},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34406.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":45718.48,"10th_percentile":45718.48,"90th_percentile":66624.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":36706.86,"10th_percentile":35806.55,"90th_percentile":45718.48,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":16165.12,"10th_percentile":16165.12,"90th_percentile":16165.12,"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":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":16165.12,"10th_percentile":14586.4,"90th_percentile":24719.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"18","median_amount":13416.99,"10th_percentile":12838.21,"90th_percentile":13437.99,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":14586.4,"10th_percentile":14586.4,"90th_percentile":14586.4,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":13443.51,"10th_percentile":13443.51,"90th_percentile":13443.51,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13443.53,"10th_percentile":13443.53,"90th_percentile":13443.53,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":41172.12,"10th_percentile":37187.26,"90th_percentile":54544.35},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":43292.1,"10th_percentile":43292.1,"90th_percentile":55948.28,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":48268.44,"10th_percentile":48268.44,"90th_percentile":48268.44,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Mcc","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11910.6,"maximum":64589.07,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":52693.0},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":52693.0},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":42306.62},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41159.76},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15880.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15880.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11910.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64589.07},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40693.93}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":40153.03,"10th_percentile":40153.03,"90th_percentile":40153.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":14131.66,"10th_percentile":14131.66,"90th_percentile":14131.66,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9411.44,"10th_percentile":9411.44,"90th_percentile":9411.44,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15929.44,"10th_percentile":15920.76,"90th_percentile":16093.42,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8522.14,"10th_percentile":8522.14,"90th_percentile":8522.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":18438.9,"10th_percentile":18438.9,"90th_percentile":18438.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders With Mcc","code_information":[{"code":"306","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9049.4,"maximum":48810.41,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":39820.47},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39820.47},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31971.41},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31104.72},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12065.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12065.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9049.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48810.41},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30752.68}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained Without Cc/Mcc","code_information":[{"code":"298","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2754.64,"maximum":14096.72,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":11500.38},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":11500.38},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":9233.52},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8983.22},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3672.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3672.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2754.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14096.72},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8881.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Mcc","code_information":[{"code":"288","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15398.64,"maximum":83824.55,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":68385.67},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":68385.67},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":54906.09},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53417.68},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20531.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20531.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15398.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83824.55},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52813.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Mcc","code_information":[{"code":"280","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9208.36,"maximum":49687.0,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":40535.61},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":40535.61},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":32545.58},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31663.33},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12277.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12277.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9208.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49687.0},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31304.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":61180.18,"10th_percentile":61180.18,"90th_percentile":61180.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":46494.36,"10th_percentile":46494.36,"90th_percentile":46494.36,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5537.42,"10th_percentile":5537.42,"90th_percentile":5537.42,"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":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":18063.96,"10th_percentile":18063.96,"90th_percentile":18063.96,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":11855.0,"10th_percentile":10467.11,"90th_percentile":12210.11,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":14682.44,"10th_percentile":14682.44,"90th_percentile":14682.44,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7079.27,"10th_percentile":7079.27,"90th_percentile":7079.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"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":10643.26,"10th_percentile":10643.26,"90th_percentile":10643.26,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10533.0,"10th_percentile":10533.0,"90th_percentile":12285.74,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9632.4,"10th_percentile":9632.4,"90th_percentile":9632.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":29395.64,"10th_percentile":29395.64,"90th_percentile":29395.64},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":51771.4,"10th_percentile":51771.4,"90th_percentile":51771.4,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":30350.22,"10th_percentile":30350.22,"90th_percentile":30350.22,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures Without Cc/Mcc","code_information":[{"code":"272","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14538.14,"maximum":79079.18,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":64514.31},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":64514.31},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":51797.82},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50393.67},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19384.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19384.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14538.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79079.18},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49823.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":57363.14,"10th_percentile":57363.14,"90th_percentile":57363.14,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12629.4,"10th_percentile":12629.4,"90th_percentile":12629.4,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System O.R. Procedures","code_information":[{"code":"264","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18961.94,"maximum":103475.09,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":84416.96},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":84416.96},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":67777.43},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65940.1},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25282.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25282.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18961.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":103475.09},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65193.81}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":24104.22,"10th_percentile":24104.22,"90th_percentile":24104.22,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Mcc","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8952.23,"maximum":48274.54,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":39383.3},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39383.3},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31620.41},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30763.23},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11936.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11936.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8952.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48274.54},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30415.06}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11726.42,"10th_percentile":11726.42,"90th_percentile":11726.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9846.33,"10th_percentile":9846.33,"90th_percentile":9846.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"1 through 10","median_amount":35037.02,"10th_percentile":35037.02,"90th_percentile":35037.02,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Cc","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5680.44,"maximum":30231.6,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24663.52},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24663.52},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19802.06},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19265.26},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7573.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7573.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5680.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30231.6},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19047.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":44772.37,"10th_percentile":44772.37,"90th_percentile":44772.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":12397.68,"10th_percentile":12397.68,"90th_percentile":12397.68,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8287.12,"10th_percentile":8287.12,"90th_percentile":8287.12,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7439.07,"10th_percentile":7439.07,"90th_percentile":7458.78,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":10618.51,"10th_percentile":10618.51,"90th_percentile":10618.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7455.39,"10th_percentile":6541.37,"90th_percentile":7464.32,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures Without Cc/Mcc","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10950.13,"maximum":59292.35,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":48371.83},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":48371.83},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":38837.2},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37784.39},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14600.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14600.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10950.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59292.35},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37356.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","code_information":[{"code":"154","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8980.31,"maximum":48429.41,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":39509.65},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39509.65},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31721.85},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30861.93},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11973.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11973.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8980.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48429.41},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30512.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Mcc","code_information":[{"code":"146","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12091.46,"maximum":65586.47,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":53506.7},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":53506.7},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":42959.93},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41795.36},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16121.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16121.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65586.47},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41322.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures Without Cc/Mcc","code_information":[{"code":"138","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5176.05,"maximum":27450.05,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22394.27},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22394.27},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17980.11},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17492.7},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6901.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6901.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5176.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27450.05},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17294.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections With Cc/Mcc","code_information":[{"code":"121","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6732.46,"maximum":36033.22,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":29396.59},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29396.59},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23602.19},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22962.38},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8976.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8976.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6732.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36033.22},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22702.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Cc","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5961.28,"maximum":31780.35,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25927.02},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25927.02},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20816.51},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20252.21},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7948.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7948.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5961.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31780.35},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20023.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7264.0,"10th_percentile":7264.0,"90th_percentile":7264.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7904.02,"10th_percentile":7904.02,"90th_percentile":7991.57,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":418.14,"10th_percentile":418.14,"90th_percentile":418.14,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":19958.76,"10th_percentile":19958.76,"90th_percentile":19958.76},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","code_information":[{"code":"063","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8083.31,"maximum":43482.71,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35474.03},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35474.03},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28481.7},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27709.61},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10777.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10777.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8083.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43482.71},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27396.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10560.53,"10th_percentile":10560.53,"90th_percentile":10560.53,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms Without Mcc","code_information":[{"code":"055","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5925.33,"maximum":31582.11,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25765.29},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25765.29},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20686.66},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20125.88},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7900.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7900.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5925.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31582.11},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19898.11}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Cc","code_information":[{"code":"038","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9312.27,"maximum":50260.04,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":41003.1},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":41003.1},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":32920.93},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32028.5},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12416.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12416.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9312.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50260.04},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31666.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":32691.67,"10th_percentile":32691.67,"90th_percentile":32691.67,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12316.49,"10th_percentile":12316.49,"90th_percentile":12316.49,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease Without Cc/Mcc","code_information":[{"code":"387","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4025.17,"maximum":21103.27,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":17216.45},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":17216.45},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13822.9},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13448.18},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5366.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5366.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4025.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21103.27},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13295.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5082.98,"10th_percentile":5082.98,"90th_percentile":5082.98,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":19773.85,"10th_percentile":19773.85,"90th_percentile":19773.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses Without Cc/Mcc","code_information":[{"code":"395","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3843.74,"maximum":20102.78,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16400.23},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16400.23},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13167.56},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12810.61},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5124.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5124.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3843.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20102.78},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12665.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":20739.45,"10th_percentile":20739.45,"90th_percentile":20739.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":12911.92,"10th_percentile":12911.92,"90th_percentile":12911.92,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4832.35,"10th_percentile":4832.35,"90th_percentile":4832.35,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","code_information":[{"code":"408","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20225.72,"maximum":110444.46,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":90102.71},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":90102.71},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":72342.46},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70381.38},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26967.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26967.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20225.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110444.46},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69584.82}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":54972.15,"10th_percentile":54972.15,"90th_percentile":54972.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Mcc","code_information":[{"code":"252","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19791.55,"maximum":108050.09,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":88149.34},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":88149.34},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":70774.12},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68855.55},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26388.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26388.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19791.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108050.09},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":68076.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":63926.98,"10th_percentile":63926.98,"90th_percentile":69599.39,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25339.34,"10th_percentile":25339.34,"90th_percentile":25339.34,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":42207.03,"10th_percentile":42207.03,"90th_percentile":42207.03,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":22776.01,"10th_percentile":22776.01,"90th_percentile":22776.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":117936.64,"10th_percentile":117936.64,"90th_percentile":117936.64},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","code_information":[{"code":"240","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16209.14,"maximum":88294.24,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":72032.14},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":72032.14},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":57833.79},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56266.02},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21612.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21612.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16209.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88294.24},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55629.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9005.11,"10th_percentile":9005.11,"90th_percentile":9005.11,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":44098.48,"10th_percentile":44098.48,"90th_percentile":44098.48,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures Without Mcc","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17888.57,"maximum":97555.76,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":79587.87},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":79587.87},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":63900.21},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62167.98},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23851.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23851.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17888.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97555.76},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61464.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":63023.72,"10th_percentile":63023.72,"90th_percentile":63023.72,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22279.27,"10th_percentile":22279.27,"90th_percentile":22279.27,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21259.17,"10th_percentile":21259.17,"90th_percentile":21259.17,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":74447.68,"10th_percentile":74447.68,"90th_percentile":74447.68,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Heart Assist System Implant","code_information":[{"code":"215","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":56124.98,"maximum":308418.08,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":251613.39},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":251613.39},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":202017.57},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":196541.22},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74833.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74833.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56124.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":308418.08},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":194316.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Signs And Symptoms","code_information":[{"code":"204","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4733.44,"maximum":25009.22,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20403.0},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20403.0},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16381.34},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15937.27},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6311.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6311.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4733.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25009.22},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15756.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Mcc","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10798.47,"maximum":58456.02,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":47689.54},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":47689.54},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":38289.4},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37251.44},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14397.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14397.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10798.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58456.02},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36829.84}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":34302.88,"10th_percentile":34302.88,"90th_percentile":34302.88,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":16504.76,"10th_percentile":16504.76,"90th_percentile":16504.76,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13979.08,"10th_percentile":13972.08,"90th_percentile":13990.3,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":24856.44,"10th_percentile":24856.44,"90th_percentile":24856.44},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion Without Cc/Mcc","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4226.81,"maximum":22215.27,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18123.64},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18123.64},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14551.27},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14156.81},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5635.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5635.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4226.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22215.27},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13996.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"547","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4895.21,"maximum":25901.3,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21130.77},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21130.77},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16965.66},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16505.75},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6526.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6526.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4895.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25901.3},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16318.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":16935.39,"10th_percentile":16935.39,"90th_percentile":16935.39,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"555","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7622.73,"maximum":40942.76,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33401.89},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33401.89},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26818.0},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26091.01},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10163.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10163.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7622.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40942.76},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25795.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10164.85,"10th_percentile":10164.85,"90th_percentile":10164.85,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","code_information":[{"code":"563","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5228.29,"maximum":27738.11,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22629.29},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22629.29},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18168.8},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17676.27},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6971.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6971.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5228.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27738.11},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17476.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4597.98,"10th_percentile":4597.98,"90th_percentile":4597.98,"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":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5122.2,"10th_percentile":5122.2,"90th_percentile":5122.2,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6772.65,"10th_percentile":4849.85,"90th_percentile":6851.56,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":6964.23,"10th_percentile":6964.23,"90th_percentile":6964.23,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Mcc","code_information":[{"code":"722","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10363.17,"maximum":56055.46,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":45731.12},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":45731.12},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36717.0},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35721.67},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13817.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13817.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10363.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56055.46},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35317.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses Without Cc/Mcc","code_information":[{"code":"730","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3972.93,"maximum":20815.2,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16981.44},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16981.44},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13634.21},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13264.61},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5297.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5297.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3972.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20815.2},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13114.48}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"741","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8208.56,"maximum":44173.45,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":36037.55},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":36037.55},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28934.14},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28149.79},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10944.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10944.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8208.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44173.45},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27831.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10229.43,"10th_percentile":10229.43,"90th_percentile":10229.43,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Cc","code_information":[{"code":"571","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9688.03,"maximum":52332.26,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":42693.67},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":42693.67},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34278.27},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33349.04},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12917.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12917.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9688.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52332.26},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32971.61}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":33980.02,"10th_percentile":33980.02,"90th_percentile":33980.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4753.62,"10th_percentile":4753.62,"90th_percentile":4753.62,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":15375.25,"10th_percentile":15375.25,"90th_percentile":15375.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","code_information":[{"code":"579","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18388.46,"maximum":100312.54,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":81836.9},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":81836.9},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":65705.93},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63924.75},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24517.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24517.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18388.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100312.54},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63201.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":58899.1,"10th_percentile":58899.1,"90th_percentile":58899.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24023.76,"10th_percentile":24023.76,"90th_percentile":24023.76,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":17377.66,"10th_percentile":17377.66,"90th_percentile":17377.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Cc","code_information":[{"code":"593","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6861.65,"maximum":36745.64,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":29977.8},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29977.8},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24068.84},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23416.38},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9148.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9148.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6861.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36745.64},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23151.36}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8280.28,"10th_percentile":8280.28,"90th_percentile":8280.28,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14603.1,"10th_percentile":14603.1,"90th_percentile":14603.1,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures With Cc/Mcc","code_information":[{"code":"746","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9955.39,"maximum":53806.67,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":43896.52},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":43896.52},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":35244.02},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34288.62},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13273.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13273.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9955.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53806.67},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33900.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Mcc","code_information":[{"code":"757","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8241.14,"maximum":44353.1,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":36184.11},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":36184.11},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29051.82},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28264.27},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10988.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10988.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8241.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44353.1},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27944.39}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","code_information":[{"code":"776","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3875.76,"maximum":20279.33,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16544.27},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16544.27},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13283.21},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12923.12},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5167.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5167.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3875.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20279.33},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12776.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":16530.65,"10th_percentile":10873.85,"90th_percentile":18030.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":7718.6,"10th_percentile":2958.1,"90th_percentile":13907.79,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"20","median_amount":3330.78,"10th_percentile":2120.58,"90th_percentile":5548.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4020.09,"10th_percentile":4020.09,"90th_percentile":4020.09,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5266.23,"10th_percentile":5266.23,"90th_percentile":5266.23,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3330.78,"10th_percentile":3330.78,"90th_percentile":3330.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5392.11,"10th_percentile":5392.11,"90th_percentile":5392.11,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":18564.59,"10th_percentile":8623.3,"90th_percentile":21045.3,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonates, Died Or Transferred To Another Acute Care Facility","code_information":[{"code":"789","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10321.04,"maximum":55823.15,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":45541.59},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":45541.59},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36564.84},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35573.63},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13761.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13761.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10321.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55823.15},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35171.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":43600.0,"10th_percentile":43600.0,"90th_percentile":43600.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":4521.0,"10th_percentile":4521.0,"90th_percentile":25371.4,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":238505.95,"10th_percentile":33274.2,"90th_percentile":805589.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6375.33,"10th_percentile":6375.33,"90th_percentile":6375.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":63000.24,"10th_percentile":63000.24,"90th_percentile":63000.24},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":61841.58,"10th_percentile":61841.58,"90th_percentile":61841.58,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Cc","code_information":[{"code":"797","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5817.49,"maximum":30987.39,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25280.11},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25280.11},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20297.12},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19746.9},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7756.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7756.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5817.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30987.39},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19523.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4426.85,"10th_percentile":4426.85,"90th_percentile":4426.85,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","code_information":[{"code":"829","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17947.54,"maximum":97881.0,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":79853.2},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":79853.2},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":64113.24},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62375.24},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23930.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23930.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17947.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97881.0},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61669.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","code_information":[{"code":"837","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27183.26,"maximum":148813.19,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":121404.66},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":121404.66},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":97474.44},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":94832.08},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36244.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36244.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27183.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":148813.19},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":93758.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":17951.53,"10th_percentile":17951.53,"90th_percentile":17951.53,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","code_information":[{"code":"845","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4981.71,"maximum":26378.31,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21519.93},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21519.93},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17278.11},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16809.73},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6642.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6642.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4981.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26378.31},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16619.48}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5754.83,"10th_percentile":5754.83,"90th_percentile":5754.83,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"855","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8607.92,"maximum":46375.77,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":37834.24},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37834.24},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30376.69},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29553.23},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11477.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11477.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8607.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46375.77},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29218.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness Without Mcc","code_information":[{"code":"866","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5082.81,"maximum":26935.86,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21974.79},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21974.79},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17643.31},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17165.03},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6777.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6777.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5082.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26935.86},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16970.77}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":17334.87,"10th_percentile":17334.87,"90th_percentile":17334.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":17951.71,"10th_percentile":17951.71,"90th_percentile":17951.71,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6665.93,"10th_percentile":6665.93,"90th_percentile":6729.47,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":5003.11,"10th_percentile":5003.11,"90th_percentile":5003.11,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":8115.76,"10th_percentile":8115.76,"90th_percentile":8115.76},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":22035.97,"10th_percentile":22035.97,"90th_percentile":22035.97,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Adjustment Reaction And Psychosocial Dysfunction","code_information":[{"code":"880","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5591.69,"maximum":29742.2,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24264.25},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24264.25},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19481.5},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18953.39},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7455.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7455.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5591.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29742.2},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18738.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":16982.16,"10th_percentile":8762.36,"90th_percentile":22784.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":19449.04,"10th_percentile":10436.86,"90th_percentile":19449.04,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2107.8,"10th_percentile":2107.8,"90th_percentile":2107.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"27","median_amount":7600.36,"10th_percentile":7360.64,"90th_percentile":10437.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6034.46,"10th_percentile":5618.13,"90th_percentile":12820.67,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7360.64,"10th_percentile":7360.64,"90th_percentile":7360.64,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9373.96,"10th_percentile":9373.96,"90th_percentile":9373.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9842.66,"10th_percentile":9842.66,"90th_percentile":9842.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":9121.91,"10th_percentile":4097.46,"90th_percentile":45535.45},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":27491.64,"10th_percentile":13716.39,"90th_percentile":32711.7,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence, Left Ama","code_information":[{"code":"894","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3663.44,"maximum":19108.48,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15589.06},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15589.06},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12516.28},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12176.99},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4884.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4884.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3663.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19108.48},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12039.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":12662.36,"10th_percentile":12662.36,"90th_percentile":12662.36,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6005.24,"10th_percentile":6005.24,"90th_percentile":6005.24,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2719.32,"10th_percentile":2719.32,"90th_percentile":2719.32,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries Without Cc/Mcc","code_information":[{"code":"905","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8530.41,"maximum":45948.32,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":37485.52},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37485.52},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30096.7},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29280.83},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11373.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11373.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8530.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45948.32},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28949.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"1 through 10","median_amount":40178.47,"10th_percentile":40178.47,"90th_percentile":40178.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions Without Mcc","code_information":[{"code":"916","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3940.91,"maximum":20638.64,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":16837.4},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":16837.4},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":13518.56},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13152.1},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5254.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5254.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3940.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20638.64},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13003.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":31384.93,"10th_percentile":31384.93,"90th_percentile":31384.93},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","code_information":[{"code":"927","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":120120.08,"maximum":661331.74,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":539527.14},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":539527.14},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":433180.29},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":421437.52},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":160160.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":160160.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":120120.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":661331.74},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":416667.82}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms With Mcc","code_information":[{"code":"947","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7328.41,"maximum":39319.67,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":32077.74},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":32077.74},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":25754.86},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25056.69},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9771.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9771.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7328.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39319.67},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24773.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9629.13,"10th_percentile":9629.13,"90th_percentile":9629.13,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":13216.93,"10th_percentile":13216.93,"90th_percentile":13216.93,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8577.33,"10th_percentile":8577.33,"90th_percentile":8577.33,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":39836.95,"10th_percentile":39836.95,"90th_percentile":39836.95,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Cc","code_information":[{"code":"958","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23867.1,"maximum":130525.55,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":106485.25},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":106485.25},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":85495.82},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":83178.17},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31822.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31822.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23867.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":130525.55},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82236.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30525.31,"10th_percentile":30525.31,"90th_percentile":30525.31,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":153523.74,"10th_percentile":153523.74,"90th_percentile":153523.74},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"1 through 10","median_amount":113727.1,"10th_percentile":113727.1,"90th_percentile":147182.3,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Cc","code_information":[{"code":"975","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7472.2,"maximum":40112.63,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":32724.65},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":32724.65},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26274.26},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25562.01},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9962.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9962.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7472.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40112.63},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25272.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"989","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6934.11,"maximum":37145.22,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30303.78},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30303.78},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24330.57},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23671.01},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9245.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9245.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6934.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37145.22},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23403.11}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Cc","code_information":[{"code":"546","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6676.86,"maximum":35726.57,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":29146.42},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29146.42},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23401.33},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22766.96},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8902.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8902.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6676.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35726.57},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22509.29}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":27218.35,"10th_percentile":27218.35,"90th_percentile":27218.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":12186.3,"10th_percentile":12186.3,"90th_percentile":12186.3,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8845.03,"10th_percentile":8845.03,"90th_percentile":8845.03,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":34112.47,"10th_percentile":34112.47,"90th_percentile":34112.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies Without Mcc","code_information":[{"code":"554","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4860.94,"maximum":25712.35,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20976.63},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20976.63},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16841.9},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16385.34},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6481.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6481.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4860.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25712.35},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16199.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6344.98,"10th_percentile":6344.98,"90th_percentile":6344.98,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","code_information":[{"code":"562","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8201.26,"maximum":44133.18,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":36004.7},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":36004.7},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28907.77},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28124.13},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10935.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10935.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8201.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44133.18},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27805.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10641.81,"10th_percentile":10641.81,"90th_percentile":10641.81,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"718","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7742.37,"maximum":41602.52,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33940.14},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33940.14},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":27250.16},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26511.45},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10323.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10323.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7742.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41602.52},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26211.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses With Cc/Mcc","code_information":[{"code":"729","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6144.95,"maximum":32793.23,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":26753.35},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":26753.35},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21479.96},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20897.68},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8193.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8193.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6144.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32793.23},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20661.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","code_information":[{"code":"740","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10362.61,"maximum":56052.36,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":45728.59},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":45728.59},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":36714.97},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35719.69},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13816.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13816.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10362.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56052.36},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35315.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5411.15,"10th_percentile":5411.15,"90th_percentile":5411.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Mcc","code_information":[{"code":"570","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16718.02,"maximum":91100.57,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":74321.6},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":74321.6},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":59671.98},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58054.37},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22290.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22290.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16718.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91100.57},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57397.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22198.41,"10th_percentile":22198.41,"90th_percentile":22198.41,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22174.02,"10th_percentile":22174.02,"90th_percentile":22174.02,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"578","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9221.27,"maximum":49758.24,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":40593.73},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":40593.73},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":32592.25},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31708.73},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12295.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12295.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9221.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49758.24},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31349.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":26164.03,"10th_percentile":26164.03,"90th_percentile":26164.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Mcc","code_information":[{"code":"592","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11068.64,"maximum":59945.92,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":48905.03},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":48905.03},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":39265.3},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38200.89},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14758.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14758.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11068.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59945.92},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37768.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10638.58,"10th_percentile":10638.58,"90th_percentile":10638.58,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","code_information":[{"code":"745","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6587.55,"maximum":35234.06,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28744.63},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28744.63},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23078.74},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22453.11},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8783.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8783.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6587.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35234.06},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22199.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"756","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5593.38,"maximum":29751.49,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24271.84},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24271.84},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19487.58},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18959.31},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7457.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7457.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5593.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29751.49},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18744.73}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion With D&C, Aspiration Curettage Or Hysterotomy","code_information":[{"code":"770","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5830.41,"maximum":31058.63,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25338.23},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25338.23},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20343.78},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19792.3},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7773.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7773.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5830.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31058.63},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19568.29}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5431.06,"10th_percentile":5431.06,"90th_percentile":5431.06,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":34083.6,"10th_percentile":34083.6,"90th_percentile":34083.6},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization Without Cc/Mcc","code_information":[{"code":"788","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5583.83,"maximum":29698.83,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":24228.88},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":24228.88},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":19453.09},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18925.75},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7445.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7445.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5583.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29698.83},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18711.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"38","median_amount":22805.0,"10th_percentile":22302.56,"90th_percentile":24760.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"28","median_amount":20371.0,"10th_percentile":20371.0,"90th_percentile":25724.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"52","median_amount":4548.78,"10th_percentile":4548.78,"90th_percentile":6614.95,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5669.97,"10th_percentile":5669.97,"90th_percentile":7784.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":46411.52,"10th_percentile":46411.52,"90th_percentile":46411.52},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":33880.91,"10th_percentile":33880.91,"90th_percentile":33880.91},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":19935.0,"10th_percentile":19935.0,"90th_percentile":74084.14,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":76177.21,"10th_percentile":76177.21,"90th_percentile":76177.21,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Mcc","code_information":[{"code":"796","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6753.25,"maximum":36147.83,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":29490.09},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29490.09},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23677.26},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23035.41},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9004.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9004.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6753.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36147.83},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22774.71}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","code_information":[{"code":"828","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9768.35,"maximum":52775.21,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":43055.03},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":43055.03},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34568.4},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33631.31},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13024.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13024.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9768.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52775.21},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33250.68}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":36051.01,"10th_percentile":36051.01,"90th_percentile":36051.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":36193.82,"10th_percentile":36193.82,"90th_percentile":36193.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11314.89,"10th_percentile":11314.89,"90th_percentile":11314.89,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia Without Cc/Mcc","code_information":[{"code":"836","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7048.13,"maximum":37774.01,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30816.77},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30816.77},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24742.44},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24071.71},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9397.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9397.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7048.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37774.01},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23799.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","code_information":[{"code":"844","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7036.34,"maximum":37708.97,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":30763.7},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":30763.7},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":24699.83},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24030.26},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9381.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9381.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7036.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37708.97},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23758.29}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Cc","code_information":[{"code":"854","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11421.38,"maximum":61891.15,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":50491.99},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":50491.99},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":40539.45},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39440.5},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15228.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15228.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11421.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61891.15},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38994.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":50491.99,"10th_percentile":50491.99,"90th_percentile":50491.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":40539.45,"10th_percentile":40539.45,"90th_percentile":40539.45,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":12565.76,"10th_percentile":12565.76,"90th_percentile":20587.42,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":14798.23,"10th_percentile":13069.23,"90th_percentile":14948.14,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4868.12,"10th_percentile":4868.12,"90th_percentile":4868.12,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":20587.42,"10th_percentile":20587.42,"90th_percentile":20587.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":46870.68,"10th_percentile":46870.68,"90th_percentile":46870.68,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":28020.15,"10th_percentile":28020.15,"90th_percentile":28020.15,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness With Mcc","code_information":[{"code":"865","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8614.1,"maximum":46409.84,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":37862.04},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37862.04},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30399.01},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29574.94},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11485.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11485.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8614.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46409.84},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29240.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":10971.03,"10th_percentile":10971.03,"90th_percentile":10971.03,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9322.59,"10th_percentile":9322.59,"90th_percentile":9322.59,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Principal Diagnosis Of Mental Illness","code_information":[{"code":"876","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21906.83,"maximum":119715.28,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":97666.02},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":97666.02},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":78414.96},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":76289.26},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29209.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29209.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21906.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119715.28},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75425.84}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Mental Disorder Diagnoses","code_information":[{"code":"887","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6213.47,"maximum":33171.13,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27061.64},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27061.64},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":21727.49},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21138.5},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8284.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8284.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6213.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33171.13},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20899.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries With Cc/Mcc","code_information":[{"code":"904","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20829.53,"maximum":113774.27,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":92819.24},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":92819.24},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":74523.53},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":72503.32},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27772.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27772.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20829.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":113774.27},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71682.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":11772.72,"10th_percentile":11772.72,"90th_percentile":11772.72,"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":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions With Mcc","code_information":[{"code":"915","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9643.66,"maximum":52087.56,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":42494.03},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":42494.03},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34117.98},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33193.1},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12858.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12858.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9643.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52087.56},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32817.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12888.23,"10th_percentile":12888.23,"90th_percentile":12888.23,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","code_information":[{"code":"923","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5914.66,"maximum":31523.26,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25717.28},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25717.28},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20648.12},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20088.38},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7886.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7886.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5914.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31523.26},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19861.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4950.88,"10th_percentile":4950.88,"90th_percentile":4950.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7727.3,"10th_percentile":7727.3,"90th_percentile":7727.3,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation Without Cc/Mcc","code_information":[{"code":"946","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6639.79,"maximum":35522.13,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28979.64},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28979.64},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23267.43},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22636.69},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8853.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8853.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6639.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35522.13},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22380.49}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Mcc","code_information":[{"code":"957","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42997.94,"maximum":236026.4,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":192554.87},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":192554.87},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":154600.15},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":150409.21},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57330.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57330.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42997.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":236026.4},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":148706.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":140836.95,"10th_percentile":140836.95,"90th_percentile":140836.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":53335.38,"10th_percentile":53335.38,"90th_percentile":53335.38,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"1 through 10","median_amount":145725.89,"10th_percentile":145725.89,"90th_percentile":145725.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Mcc","code_information":[{"code":"974","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16408.54,"maximum":89393.85,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":72929.22},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":72929.22},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":58554.05},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56966.75},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21878.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21878.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16408.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89393.85},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56322.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":48323.65,"10th_percentile":48323.65,"90th_percentile":48323.65,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"988","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9430.22,"maximum":50910.51,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":41533.77},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":41533.77},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33347.0},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32443.02},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12573.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12573.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9430.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50910.51},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32075.84}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":34815.92,"10th_percentile":34815.92,"90th_percentile":34815.92,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11699.01,"10th_percentile":11699.01,"90th_percentile":12721.07,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"1 through 10","median_amount":70633.5,"10th_percentile":70633.5,"90th_percentile":70633.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","code_information":[{"code":"097","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20485.22,"maximum":111875.51,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":91270.19},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":91270.19},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":73279.81},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71293.32},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27313.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27313.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20485.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":111875.51},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70486.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":72727.95,"10th_percentile":72727.95,"90th_percentile":72727.95,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Cc","code_information":[{"code":"089","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6369.06,"maximum":34029.14,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27761.62},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27761.62},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22289.5},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21685.27},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8492.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8492.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6369.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34029.14},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21439.84}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7969.44,"10th_percentile":7969.44,"90th_percentile":7969.44,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma Without Mcc","code_information":[{"code":"081","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5228.85,"maximum":27741.21,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22631.81},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22631.81},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18170.83},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17678.25},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6971.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6971.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5228.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27741.21},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17478.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5754.3,"10th_percentile":5754.3,"90th_percentile":5754.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Mcc","code_information":[{"code":"034","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21939.41,"maximum":119894.93,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":97812.59},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":97812.59},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":78532.63},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":76403.75},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29252.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29252.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21939.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119894.93},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75539.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":78819.72,"10th_percentile":78819.72,"90th_percentile":78819.72},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":70068.7,"10th_percentile":70068.7,"90th_percentile":70068.7,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Cc","code_information":[{"code":"026","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17662.22,"maximum":96307.47,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":78569.48},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":78569.48},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":63082.56},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61372.5},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23549.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23549.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17662.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96307.47},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60677.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":75467.23,"10th_percentile":75467.23,"90th_percentile":75467.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":7696.95,"10th_percentile":7696.95,"90th_percentile":7696.95,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":16563.71,"10th_percentile":16563.71,"90th_percentile":16563.71,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22561.24,"10th_percentile":22561.24,"90th_percentile":22561.24,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":17155.93,"10th_percentile":17155.93,"90th_percentile":17155.93,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":90222.8,"10th_percentile":90222.8,"90th_percentile":90222.8,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":23383.46,"10th_percentile":23383.46,"90th_percentile":23383.46,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","code_information":[{"code":"018","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":242747.9,"maximum":1337587.23,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":1091229.36},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":1091229.36},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":876135.83},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":852385.29},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":323663.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":323663.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":242747.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1337587.23},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":842738.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas, Islet Cell And Kidney Transplant","code_information":[{"code":"008","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31678.4,"maximum":173602.49,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":141628.24},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":141628.24},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":113711.73},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":110629.2},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42237.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42237.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31678.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":173602.49},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":109377.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Cc","code_information":[{"code":"412","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12007.77,"maximum":65124.94,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":53130.18},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":53130.18},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":42657.62},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41501.25},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16010.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16010.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12007.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65124.94},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41031.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Mcc","code_information":[{"code":"420","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19335.46,"maximum":105534.92,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":86097.42},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":86097.42},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":69126.65},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67252.75},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25780.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25780.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19335.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":105534.92},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":66491.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","code_information":[{"code":"428","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31776.13,"maximum":174141.45,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":142067.94},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":142067.94},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":114064.76},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":110972.66},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42368.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42368.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31776.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":174141.45},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":109716.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":21228.44,"10th_percentile":21228.44,"90th_percentile":21228.44,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40828.14,"10th_percentile":40828.14,"90th_percentile":40828.14,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","code_information":[{"code":"437","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4991.26,"maximum":26430.97,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":21562.89},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":21562.89},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17312.6},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16843.29},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6655.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6655.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4991.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26430.97},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16652.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Cc","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6345.47,"maximum":33899.04,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27655.49},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27655.49},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22204.28},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21602.36},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8460.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8460.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6345.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33899.04},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21357.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":28675.47,"10th_percentile":28675.47,"90th_percentile":28675.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":22003.42,"10th_percentile":22003.42,"90th_percentile":35396.28,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8182.39,"10th_percentile":8105.92,"90th_percentile":8290.13,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8106.93,"10th_percentile":8106.93,"90th_percentile":8106.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":33899.04,"10th_percentile":33899.04,"90th_percentile":33899.04,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Or Infection Without Cc/Mcc","code_information":[{"code":"458","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23635.12,"maximum":129246.29,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":105441.6},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":105441.6},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":84657.88},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82362.95},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31513.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31513.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23635.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":129246.29},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":81430.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32047.98,"10th_percentile":32047.98,"90th_percentile":32047.98,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement Without Cc/Mcc","code_information":[{"code":"468","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15633.42,"maximum":85119.3,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":69441.96},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":69441.96},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":55754.17},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54242.77},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20844.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20844.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15633.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85119.3},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53628.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":44390.51,"10th_percentile":44390.51,"90th_percentile":44390.51,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"476","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6827.39,"maximum":36556.7,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":29823.65},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29823.65},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23945.08},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23295.97},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9103.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9103.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6827.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36556.7},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23032.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":44413.37,"10th_percentile":44413.37,"90th_percentile":44413.37},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Mcc","code_information":[{"code":"485","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18324.44,"maximum":99959.42,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":81548.82},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":81548.82},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":65474.63},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63699.73},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24432.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24432.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18324.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99959.42},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62978.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","code_information":[{"code":"495","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20563.29,"maximum":112306.06,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":91621.44},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":91621.44},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":73561.83},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71567.69},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27417.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27417.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20563.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112306.06},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70757.71}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Mcc","code_information":[{"code":"503","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15875.5,"maximum":86454.32,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":70531.1},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":70531.1},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":56628.63},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55093.52},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21167.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21167.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15875.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86454.32},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54469.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19618.66,"10th_percentile":19618.66,"90th_percentile":19618.66,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","code_information":[{"code":"512","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9496.5,"maximum":51276.02,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":41831.96},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":41831.96},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":33586.41},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32675.94},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12662.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12662.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9496.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51276.02},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32306.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9153.0,"10th_percentile":9153.0,"90th_percentile":9153.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","code_information":[{"code":"520","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8589.38,"maximum":46273.55,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":37750.85},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37750.85},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30309.74},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29488.09},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11452.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11452.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8589.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46273.55},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29154.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":36216.96,"10th_percentile":36216.96,"90th_percentile":36216.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10679.57,"10th_percentile":10679.57,"90th_percentile":11221.7,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","code_information":[{"code":"538","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4244.22,"maximum":22311.29,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18201.98},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18201.98},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":14614.17},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14218.0},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5658.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5658.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4244.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22311.29},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14057.09}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","code_information":[{"code":"604","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8466.94,"maximum":45598.3,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":37199.97},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37199.97},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":29867.44},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29057.78},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11289.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11289.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8466.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45598.3},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28728.91}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9443.4,"10th_percentile":9443.4,"90th_percentile":9443.4,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"618","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8164.76,"maximum":43931.84,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":35840.44},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":35840.44},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":28775.89},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27995.82},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10886.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10886.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8164.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43931.84},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27678.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","code_information":[{"code":"626","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8620.28,"maximum":46443.92,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":37889.84},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37889.84},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30421.33},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29596.66},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11493.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11493.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8620.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46443.92},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29261.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":37757.08,"10th_percentile":37757.08,"90th_percentile":37757.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8628.32,"10th_percentile":8628.32,"90th_percentile":8628.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Cc","code_information":[{"code":"800","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15978.29,"maximum":87021.17,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":70993.54},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":70993.54},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":56999.92},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55454.75},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21304.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21304.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15978.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87021.17},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54827.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19850.54,"10th_percentile":19850.54,"90th_percentile":19850.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"808","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12599.78,"maximum":68389.7,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":55793.63},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":55793.63},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":44796.08},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43581.74},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16799.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16799.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12599.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68389.7},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43088.49}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":10481.1,"10th_percentile":10481.1,"90th_percentile":10481.1,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16927.56,"10th_percentile":16927.56,"90th_percentile":16927.56,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","code_information":[{"code":"816","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3748.26,"maximum":19576.2,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":15970.64},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":15970.64},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":12822.65},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12475.05},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4997.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4997.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3748.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19576.2},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12333.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","code_information":[{"code":"640","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7700.24,"maximum":41370.21,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33750.61},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33750.61},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":27097.99},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26363.41},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10266.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10266.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7700.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41370.21},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26065.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":28372.15,"10th_percentile":28372.15,"90th_percentile":28372.15,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6798.35,"10th_percentile":6798.35,"90th_percentile":6798.35,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":9911.41,"10th_percentile":8541.77,"90th_percentile":10060.07,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4504.28,"10th_percentile":4504.28,"90th_percentile":4504.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6842.08,"10th_percentile":6842.08,"90th_percentile":13338.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9883.41,"10th_percentile":9883.41,"90th_percentile":9883.41,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":8957.03,"10th_percentile":8957.03,"90th_percentile":8957.03,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant","code_information":[{"code":"652","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18337.91,"maximum":100033.76,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":81609.47},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":81609.47},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":65523.33},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63747.1},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24450.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24450.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18337.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100033.76},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63025.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Cc","code_information":[{"code":"660","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7622.17,"maximum":40939.66,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33399.36},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33399.36},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26815.97},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26089.04},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10162.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10162.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7622.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40939.66},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25793.77}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":24157.41,"10th_percentile":24157.41,"90th_percentile":24157.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":16421.7,"10th_percentile":16421.7,"90th_percentile":16421.7,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":11362.53,"10th_percentile":11362.53,"90th_percentile":11362.53,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10068.18,"10th_percentile":9990.56,"90th_percentile":10333.56,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5389.68,"10th_percentile":5389.68,"90th_percentile":5389.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5178.89,"10th_percentile":5178.89,"90th_percentile":5178.89,"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","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9490.33,"10th_percentile":9490.33,"90th_percentile":9490.33,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":15328.91,"10th_percentile":15328.91,"90th_percentile":16374.05},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":25387.03,"10th_percentile":25387.03,"90th_percentile":25387.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Mcc","code_information":[{"code":"668","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16599.51,"maximum":90447.0,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":73788.4},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":73788.4},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":59243.88},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57637.88},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22132.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22132.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16599.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90447.0},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56985.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Mcc","code_information":[{"code":"682","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8516.92,"maximum":45873.98,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":37424.87},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":37424.87},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":30048.01},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29233.46},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11355.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11355.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8516.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45873.98},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28902.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":91524.48,"10th_percentile":91524.48,"90th_percentile":91524.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":30472.05,"10th_percentile":30472.05,"90th_percentile":30472.05,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11161.29,"10th_percentile":10958.29,"90th_percentile":11175.29,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":17661.87,"10th_percentile":17661.87,"90th_percentile":17661.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"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":11155.22,"10th_percentile":11155.22,"90th_percentile":11155.22,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10368.45,"10th_percentile":10368.45,"90th_percentile":11155.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":27747.03,"10th_percentile":27747.03,"90th_percentile":27747.03},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones With Mcc","code_information":[{"code":"693","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7750.23,"maximum":41645.89,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":33975.52},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":33975.52},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":27278.56},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26539.09},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10333.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10333.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7750.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41645.89},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26238.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures With Cc/Mcc","code_information":[{"code":"707","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11433.74,"maximum":61959.29,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":50547.58},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":50547.58},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":40584.09},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39483.92},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15244.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15244.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11433.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61959.29},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39037.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Mcc","code_information":[{"code":"545","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14137.66,"maximum":76870.66,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":62712.56},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":62712.56},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":50351.21},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48986.28},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18850.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18850.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14137.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76870.66},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48431.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":36742.09,"10th_percentile":36742.09,"90th_percentile":36742.09,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies With Mcc","code_information":[{"code":"553","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7479.5,"maximum":40152.89,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":32757.5},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":32757.5},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":26300.63},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25587.67},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9972.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9972.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7479.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40152.89},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25298.07}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"561","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4713.79,"maximum":24900.8,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20314.55},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20314.55},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16310.33},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15868.18},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6285.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6285.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4713.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24900.8},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15688.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7717.94,"10th_percentile":7717.94,"90th_percentile":7717.94,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures With Cc/Mcc","code_information":[{"code":"717","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10817.01,"maximum":58558.24,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":47772.94},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":47772.94},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":38356.35},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37316.58},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14422.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14422.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10817.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58558.24},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36894.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13741.29,"10th_percentile":13741.29,"90th_percentile":13741.29,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":13741.29,"10th_percentile":13741.29,"90th_percentile":13741.29,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System Without Mcc","code_information":[{"code":"728","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4754.79,"maximum":25126.92,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":20499.02},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":20499.02},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":16458.44},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16012.28},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6339.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6339.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4754.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25126.92},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15831.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5417.78,"10th_percentile":5417.78,"90th_percentile":5417.78,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","code_information":[{"code":"739","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20322.33,"maximum":110977.23,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":90537.36},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":90537.36},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":72691.43},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70720.89},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27096.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27096.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20322.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110977.23},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69920.49}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","code_information":[{"code":"566","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4407.1,"maximum":23209.57,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":18934.81},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":18934.81},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15202.55},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14790.43},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5876.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5876.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4407.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23209.57},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14623.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20186.92,"10th_percentile":20186.92,"90th_percentile":20186.92,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"577","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15086.9,"maximum":82105.43,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":66983.19},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":66983.19},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":53780.05},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52322.17},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20115.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20115.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15086.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82105.43},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51730.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","code_information":[{"code":"585","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11033.82,"maximum":59753.87,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":48748.36},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":48748.36},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":39139.51},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38078.5},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14711.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14711.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11033.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59753.87},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37647.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":10271.85,"10th_percentile":10271.85,"90th_percentile":10271.85,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":41080.03,"10th_percentile":41080.03,"90th_percentile":41080.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"599","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4520.01,"maximum":23832.17,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":19442.74},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":19442.74},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":15610.36},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15187.19},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6026.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6026.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4520.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23832.17},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15015.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Cc","code_information":[{"code":"755","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6308.4,"maximum":33694.61,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":27488.71},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":27488.71},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22070.37},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21472.08},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8411.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8411.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6308.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33694.61},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21229.07}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses With O.R. Procedures","code_information":[{"code":"769","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9689.72,"maximum":52341.56,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":42701.25},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":42701.25},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":34284.35},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33354.96},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12919.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12919.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9689.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52341.56},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32977.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":28191.57,"10th_percentile":28191.57,"90th_percentile":28191.57,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7571.16,"10th_percentile":7571.16,"90th_percentile":7571.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Cc","code_information":[{"code":"787","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6471.28,"maximum":34592.88,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":28221.54},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":28221.54},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":22658.76},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22044.52},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8628.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8628.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6471.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34592.88},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21795.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"13","median_amount":23526.0,"10th_percentile":22805.0,"90th_percentile":25674.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"14","median_amount":21328.0,"10th_percentile":20371.0,"90th_percentile":24569.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"43","median_amount":5512.46,"10th_percentile":4462.47,"90th_percentile":5669.97,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7467.65,"10th_percentile":7467.65,"90th_percentile":7784.31,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5669.97,"10th_percentile":4548.78,"90th_percentile":7467.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6298.36,"10th_percentile":6298.36,"90th_percentile":6298.36,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":26787.11,"10th_percentile":26787.11,"90th_percentile":26787.11},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":19935.0,"10th_percentile":19935.0,"90th_percentile":21685.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Normal Newborn","code_information":[{"code":"795","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":1320.68,"maximum":6188.81,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":5048.95},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":5048.95},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":4053.74},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":3943.85},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1760.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1760.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1320.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6188.81},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":3899.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"94","median_amount":3648.0,"10th_percentile":1824.0,"90th_percentile":5472.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"86","median_amount":3360.0,"10th_percentile":1680.0,"90th_percentile":5277.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1549.9,"10th_percentile":1549.9,"90th_percentile":1549.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1585.52,"10th_percentile":1585.52,"90th_percentile":2271.12,"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":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"246","median_amount":1569.82,"10th_percentile":1549.9,"90th_percentile":2248.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1569.82,"10th_percentile":1549.9,"90th_percentile":1569.82,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"12","median_amount":1569.82,"10th_percentile":1569.82,"90th_percentile":2248.63,"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":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":5635.71,"10th_percentile":3153.06,"90th_percentile":7654.01},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2248.63,"10th_percentile":2248.63,"90th_percentile":2248.63,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":3312.53,"10th_percentile":3312.53,"90th_percentile":3719.21},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"26","median_amount":4350.0,"10th_percentile":2575.94,"90th_percentile":7250.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"1 through 10","median_amount":4502.56,"10th_percentile":3912.61,"90th_percentile":5659.13,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"1 through 10","median_amount":822.73,"10th_percentile":822.73,"90th_percentile":822.73,"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."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","code_information":[{"code":"827","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13180.0,"maximum":71589.42,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":58404.02},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":58404.02},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":46891.94},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45620.78},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17573.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17573.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13180.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71589.42},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45104.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17451.26,"10th_percentile":17451.26,"90th_percentile":17451.26,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Cc","code_information":[{"code":"835","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11913.98,"maximum":64607.66,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":52708.17},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":52708.17},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":42318.8},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41171.61},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15885.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15885.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11913.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64607.66},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40705.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":51214.65,"10th_percentile":51214.65,"90th_percentile":51214.65,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15800.64,"10th_percentile":15800.64,"90th_percentile":15800.64,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","code_information":[{"code":"843","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11402.84,"maximum":61788.93,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":50408.6},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":50408.6},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":40472.5},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39375.36},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15203.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15203.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11402.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61788.93},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38929.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","code_information":[{"code":"853","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27937.6,"maximum":152973.14,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":124798.42},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":124798.42},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":100199.26},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":97483.03},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37250.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37250.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27937.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":152973.14},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":96379.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":107552.43,"10th_percentile":107552.43,"90th_percentile":107552.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":73807.57,"10th_percentile":49166.66,"90th_percentile":213603.38,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":37819.08,"10th_percentile":37819.08,"90th_percentile":37819.08,"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":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"11","median_amount":37819.08,"10th_percentile":20587.42,"90th_percentile":40456.47,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"20","median_amount":35740.28,"10th_percentile":22026.78,"90th_percentile":36810.51,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":157415.94,"10th_percentile":157415.94,"90th_percentile":157415.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"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":36768.51,"10th_percentile":36748.28,"90th_percentile":36927.13,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36748.28,"10th_percentile":35169.17,"90th_percentile":81035.88,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":52575.85,"10th_percentile":52575.85,"90th_percentile":52575.85},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":120558.13,"10th_percentile":120558.13,"90th_percentile":120558.13,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fever And Inflammatory Conditions","code_information":[{"code":"864","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5184.47,"maximum":27496.51,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22432.18},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22432.18},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":18010.55},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17522.31},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6912.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6912.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5184.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27496.51},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17324.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4898.57,"10th_percentile":4898.57,"90th_percentile":4898.57,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":19969.8,"10th_percentile":19969.8,"90th_percentile":19969.8},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":26299.58,"10th_percentile":26299.58,"90th_percentile":26299.58},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","code_information":[{"code":"872","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5946.11,"maximum":31696.72,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":25858.79},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":25858.79},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":20761.73},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20198.92},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7928.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7928.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5946.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31696.72},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19970.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":23328.04,"10th_percentile":17143.96,"90th_percentile":67672.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":20917.96,"10th_percentile":17863.44,"90th_percentile":73685.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4864.35,"10th_percentile":4864.35,"90th_percentile":4864.35,"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":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6169.67,"10th_percentile":6169.67,"90th_percentile":33712.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"20","median_amount":7722.44,"10th_percentile":6726.28,"90th_percentile":7815.54,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6169.67,"10th_percentile":6169.67,"90th_percentile":6169.67,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","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":6588.68,"10th_percentile":6116.08,"90th_percentile":7780.54,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6520.22,"10th_percentile":6520.22,"90th_percentile":6520.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":61493.56,"10th_percentile":61493.56,"90th_percentile":61493.56},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5995.64,"10th_percentile":5995.64,"90th_percentile":5995.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":102393.67,"10th_percentile":102393.67,"90th_percentile":102393.67},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"1 through 10","median_amount":80685.23,"10th_percentile":80685.23,"90th_percentile":80685.23,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"1 through 10","median_amount":14449.96,"10th_percentile":14449.96,"90th_percentile":14449.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Behavioral And Developmental Disorders","code_information":[{"code":"886","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11855.0,"maximum":64282.42,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":52442.83},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":52442.83},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":42105.76},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40964.35},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15806.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15806.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11855.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64282.42},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40500.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries Without Cc/Mcc","code_information":[{"code":"903","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6767.85,"maximum":36228.36,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":29555.79},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":29555.79},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":23730.01},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23086.73},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9023.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9023.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6767.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36228.36},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22825.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":476.66,"10th_percentile":476.66,"90th_percentile":476.66,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury Without Mcc","code_information":[{"code":"914","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5172.12,"maximum":27428.36,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":22376.59},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":22376.59},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":17965.91},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17478.88},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6896.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6896.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5172.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27428.36},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17281.06}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3120.75,"10th_percentile":3120.75,"90th_percentile":3120.75,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5644.85,"10th_percentile":5644.85,"90th_percentile":5644.85,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5312.4,"10th_percentile":5312.4,"90th_percentile":5312.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","code_information":[{"code":"922","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10024.48,"maximum":54187.67,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":44207.34},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":44207.34},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":35493.58},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34531.41},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13365.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13365.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10024.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54187.67},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34140.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation With Cc/Mcc","code_information":[{"code":"945","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8896.62,"maximum":47967.89,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":39133.12},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":39133.12},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":31419.55},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30567.82},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11862.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11862.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8896.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47967.89},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30221.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","code_information":[{"code":"956","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21334.48,"maximum":116558.93,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":95091.01},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":95091.01},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":76347.51},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74277.86},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28445.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28445.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21334.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116558.93},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":73437.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures Without Mcc","code_information":[{"code":"970","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15012.2,"maximum":81693.47,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":66647.1},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":66647.1},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":53510.21},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52059.64},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20016.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20016.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15012.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81693.47},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51470.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"987","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19455.1,"maximum":106194.69,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":86635.67},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":86635.67},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":69558.81},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67673.19},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25940.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25940.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19455.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106194.69},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":66907.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"1 through 10","median_amount":49863.67,"10th_percentile":49863.67,"90th_percentile":49863.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"1 through 10","median_amount":71066.28,"10th_percentile":71066.28,"90th_percentile":71066.28,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25816.34,"10th_percentile":25816.34,"90th_percentile":25816.34,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23774.79,"10th_percentile":23774.79,"90th_percentile":23774.79,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive Burns","code_information":[{"code":"935","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11769.06,"maximum":63808.5,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"fee schedule","standard_charge_dollar":52056.2},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":52056.2},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"fee schedule","standard_charge_dollar":41795.34},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40662.34},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15692.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15692.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11769.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63808.5},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40202.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"459","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":167598.22,"maximum":167598.22,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":167598.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","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","minimum":154558.9,"maximum":154558.9,"payers_information":[{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"fee schedule","standard_charge_dollar":154558.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, bupivacaine liposome","code_information":[{"code":"0763","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":41812.86,"10th_percentile":41812.86,"90th_percentile":41812.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ketorolac tromethamine inj","code_information":[{"code":"0764","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":21737.93,"10th_percentile":7300.53,"90th_percentile":60479.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":6593.15,"10th_percentile":4964.38,"90th_percentile":26813.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1306.65,"10th_percentile":968.33,"90th_percentile":4558.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2611.0,"10th_percentile":2611.0,"90th_percentile":2611.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2791.17,"10th_percentile":2791.17,"90th_percentile":2791.17,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":713.96,"10th_percentile":713.96,"90th_percentile":713.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":22662.4,"10th_percentile":22662.4,"90th_percentile":22662.4},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":78488.93,"10th_percentile":78488.93,"90th_percentile":78488.93,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj cefazolin sodium, hikma","code_information":[{"code":"0788","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":40.3,"10th_percentile":40.3,"90th_percentile":40.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5452.5,"10th_percentile":5452.5,"90th_percentile":5452.5,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, glycopyrrolate, 0.1 mg","code_information":[{"code":"0792","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":17511.49,"10th_percentile":17511.49,"90th_percentile":17511.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":14967.88,"10th_percentile":14967.88,"90th_percentile":14967.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Albumin (human), 5%, 250 ml","code_information":[{"code":"0963","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":9913.61,"10th_percentile":9913.61,"90th_percentile":9913.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"New Technology - Level 22 ($2001-$2500)","code_information":[{"code":"1522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":5730.52,"10th_percentile":5730.52,"90th_percentile":5730.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"33","median_amount":6228.77,"10th_percentile":4315.48,"90th_percentile":9579.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"44","median_amount":5738.3,"10th_percentile":4868.77,"90th_percentile":9918.35,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"1 through 10","median_amount":1435.76,"10th_percentile":1435.76,"90th_percentile":1435.76,"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":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"31","median_amount":685.29,"10th_percentile":685.29,"90th_percentile":685.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"145","median_amount":2134.32,"10th_percentile":1958.82,"90th_percentile":4644.67,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"11","median_amount":685.29,"10th_percentile":656.46,"90th_percentile":685.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1756.77,"10th_percentile":1704.26,"90th_percentile":4212.23,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1252.76,"10th_percentile":1252.76,"90th_percentile":1252.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1619.88,"10th_percentile":1619.88,"90th_percentile":1619.88,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":11796.82,"10th_percentile":10470.24,"90th_percentile":21443.87},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":675.1,"10th_percentile":675.1,"90th_percentile":675.1,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":16440.85,"10th_percentile":16440.85,"90th_percentile":18968.4},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"33","median_amount":8523.52,"10th_percentile":7433.4,"90th_percentile":18610.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":9771.74,"10th_percentile":9771.74,"90th_percentile":17405.51,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endo, single, pulmonary","code_information":[{"code":"2042","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":400.0,"10th_percentile":400.0,"90th_percentile":400.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":152.8,"10th_percentile":152.8,"90th_percentile":152.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":365.0,"10th_percentile":365.0,"90th_percentile":365.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":74.95,"10th_percentile":67.73,"90th_percentile":152.69,"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":"Dean 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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":76.24,"10th_percentile":76.24,"90th_percentile":138.75,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":134.74,"10th_percentile":134.74,"90th_percentile":134.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":634.56,"10th_percentile":634.56,"90th_percentile":634.56},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":277.37,"10th_percentile":277.37,"90th_percentile":277.37,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":606.65,"10th_percentile":606.65,"90th_percentile":606.65,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":276.7,"10th_percentile":276.7,"90th_percentile":276.7,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"11","median_amount":1500.3,"10th_percentile":1500.3,"90th_percentile":2070.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"38","median_amount":391.0,"10th_percentile":171.69,"90th_percentile":391.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"36","median_amount":365.0,"10th_percentile":254.26,"90th_percentile":382.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"16","median_amount":73.3,"10th_percentile":58.89,"90th_percentile":152.69,"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":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":86.3,"10th_percentile":79.23,"90th_percentile":223.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"362","median_amount":81.85,"10th_percentile":56.65,"90th_percentile":211.85,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":152.7,"10th_percentile":152.4,"90th_percentile":262.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"18","median_amount":78.44,"10th_percentile":58.89,"90th_percentile":154.25,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"23","median_amount":76.24,"10th_percentile":56.28,"90th_percentile":123.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":75.18,"10th_percentile":42.1,"90th_percentile":155.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":77.12,"10th_percentile":58.27,"90th_percentile":86.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":119.92,"10th_percentile":119.92,"90th_percentile":149.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":803.16,"10th_percentile":737.13,"90th_percentile":1139.52},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"25","median_amount":70.26,"10th_percentile":58.89,"90th_percentile":219.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"16","median_amount":897.75,"10th_percentile":310.43,"90th_percentile":1504.25},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"22","median_amount":948.59,"10th_percentile":756.59,"90th_percentile":1752.63,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"51","median_amount":1466.48,"10th_percentile":798.07,"90th_percentile":1857.6,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Type A ED Visits","code_information":[{"code":"5023","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":1140.0,"10th_percentile":1140.0,"90th_percentile":1140.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"272","median_amount":1575.0,"10th_percentile":952.95,"90th_percentile":1633.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"214","median_amount":1364.0,"10th_percentile":614.0,"90th_percentile":1428.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"59","median_amount":102.27,"10th_percentile":70.26,"90th_percentile":244.78,"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":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":110.08,"10th_percentile":75.94,"90th_percentile":483.78,"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":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1166","median_amount":102.27,"10th_percentile":67.13,"90th_percentile":256.62,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"239","median_amount":267.45,"10th_percentile":165.31,"90th_percentile":487.43,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":2081.04,"10th_percentile":2081.04,"90th_percentile":2081.04},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"97","median_amount":92.71,"10th_percentile":62.42,"90th_percentile":244.33,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"95","median_amount":93.14,"10th_percentile":58.89,"90th_percentile":230.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"87","median_amount":240.0,"10th_percentile":154.3,"90th_percentile":397.42,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"19","median_amount":92.72,"10th_percentile":70.59,"90th_percentile":192.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"50","median_amount":259.96,"10th_percentile":209.68,"90th_percentile":446.41,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"29","median_amount":2206.46,"10th_percentile":1551.12,"90th_percentile":6162.04},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":1772.0,"10th_percentile":1541.64,"90th_percentile":2323.51},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"1 through 10","median_amount":2705.47,"10th_percentile":2705.47,"90th_percentile":2705.47},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"124","median_amount":87.25,"10th_percentile":64.75,"90th_percentile":236.5,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"116","median_amount":1636.76,"10th_percentile":1239.01,"90th_percentile":3542.3},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"106","median_amount":1689.12,"10th_percentile":1115.73,"90th_percentile":3210.76,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"32","median_amount":1416.5,"10th_percentile":638.36,"90th_percentile":3083.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"234","median_amount":2381.4,"10th_percentile":1594.8,"90th_percentile":3564.27,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"1 through 10","median_amount":1421.87,"10th_percentile":1421.87,"90th_percentile":1421.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Type A ED Visits","code_information":[{"code":"5024","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":3961.0,"10th_percentile":3961.0,"90th_percentile":3961.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"385","median_amount":3961.0,"10th_percentile":2362.0,"90th_percentile":4664.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"395","median_amount":3761.0,"10th_percentile":2253.81,"90th_percentile":4147.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"38","median_amount":220.72,"10th_percentile":88.62,"90th_percentile":457.95,"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":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"12","median_amount":320.45,"10th_percentile":187.51,"90th_percentile":460.35,"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":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1059","median_amount":250.07,"10th_percentile":92.82,"90th_percentile":497.38,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"472","median_amount":613.65,"10th_percentile":405.58,"90th_percentile":943.08,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"76","median_amount":226.49,"10th_percentile":76.48,"90th_percentile":486.33,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"124","median_amount":226.49,"10th_percentile":77.16,"90th_percentile":478.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"117","median_amount":467.94,"10th_percentile":295.28,"90th_percentile":842.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"100","median_amount":3407.96,"10th_percentile":2131.09,"90th_percentile":6856.91},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"193","median_amount":3610.88,"10th_percentile":2054.38,"90th_percentile":7013.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"27","median_amount":2883.39,"10th_percentile":1197.95,"90th_percentile":8013.34,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"71","median_amount":3572.83,"10th_percentile":2289.48,"90th_percentile":7938.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"1 through 10","median_amount":688.46,"10th_percentile":688.46,"90th_percentile":688.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"98","median_amount":459.55,"10th_percentile":181.9,"90th_percentile":786.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"84","median_amount":834.65,"10th_percentile":549.44,"90th_percentile":2398.55,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"43","median_amount":462.02,"10th_percentile":178.76,"90th_percentile":793.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"81","median_amount":895.52,"10th_percentile":611.51,"90th_percentile":2125.2,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"46","median_amount":8900.59,"10th_percentile":4583.32,"90th_percentile":20531.19},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":4681.34,"10th_percentile":4681.34,"90th_percentile":5992.9},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"1 through 10","median_amount":490.0,"10th_percentile":490.0,"90th_percentile":490.0},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"1 through 10","median_amount":14793.97,"10th_percentile":14793.97,"90th_percentile":14793.97},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"78","median_amount":485.9,"10th_percentile":200.48,"90th_percentile":954.5,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"91","median_amount":5870.2,"10th_percentile":3735.5,"90th_percentile":13689.56},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"137","median_amount":6145.6,"10th_percentile":2990.35,"90th_percentile":13767.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"24","median_amount":4161.52,"10th_percentile":3178.18,"90th_percentile":11689.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"27","median_amount":10781.36,"10th_percentile":5479.03,"90th_percentile":21360.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"1 through 10","median_amount":4403.76,"10th_percentile":4403.76,"90th_percentile":4403.76,"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":"Critical Care","code_information":[{"code":"5041","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":12380.0,"10th_percentile":10493.0,"90th_percentile":12380.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"11","median_amount":10493.0,"10th_percentile":5236.0,"90th_percentile":10493.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":986.18,"10th_percentile":986.18,"90th_percentile":986.18,"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":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"27","median_amount":714.72,"10th_percentile":147.7,"90th_percentile":1346.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"33","median_amount":2514.35,"10th_percentile":1723.89,"90th_percentile":2728.65,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1314.81,"10th_percentile":1314.81,"90th_percentile":9220.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2403.69,"10th_percentile":2221.27,"90th_percentile":2523.04,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2171.22,"10th_percentile":2171.22,"90th_percentile":2466.59,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":9364.29,"10th_percentile":9364.29,"90th_percentile":9364.29},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":970.57,"10th_percentile":585.85,"90th_percentile":1248.34,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":15246.18,"10th_percentile":15246.18,"90th_percentile":27569.92},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":14212.76,"10th_percentile":14212.76,"90th_percentile":14212.76,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":17399.09,"10th_percentile":17399.09,"90th_percentile":17399.09,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":6766.59,"10th_percentile":6766.59,"90th_percentile":6766.59,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Skin Procedures","code_information":[{"code":"5051","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"13","median_amount":1575.0,"10th_percentile":1574.99,"90th_percentile":1579.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":3358.4,"10th_percentile":994.92,"90th_percentile":3738.72,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"16","median_amount":169.2,"10th_percentile":161.98,"90th_percentile":169.2,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":264.3,"10th_percentile":139.6,"90th_percentile":267.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":169.2,"10th_percentile":169.2,"90th_percentile":169.2,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":169.2,"10th_percentile":169.2,"90th_percentile":169.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":193.74,"10th_percentile":193.74,"90th_percentile":193.74,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":3380.63,"10th_percentile":1672.5,"90th_percentile":16770.1},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":3786.03,"10th_percentile":3786.03,"90th_percentile":3786.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"20","median_amount":2485.92,"10th_percentile":1840.79,"90th_percentile":3272.3,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":1364.0,"10th_percentile":1364.0,"90th_percentile":5236.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":4198.0,"10th_percentile":4197.99,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":239.1,"10th_percentile":76.35,"90th_percentile":257.45,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":385.91,"10th_percentile":378.19,"90th_percentile":787.93,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":163.6,"10th_percentile":163.6,"90th_percentile":163.6,"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":"ICare","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":302.56,"10th_percentile":302.56,"90th_percentile":302.56,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":490.69,"10th_percentile":490.69,"90th_percentile":490.69,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":1813.44,"10th_percentile":1813.44,"90th_percentile":1813.44},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":2185.63,"10th_percentile":2185.63,"90th_percentile":3894.52,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":7648.32,"10th_percentile":7648.32,"90th_percentile":7648.32,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":3465.12,"10th_percentile":2167.58,"90th_percentile":16975.16,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Skin Procedures","code_information":[{"code":"5053","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":4836.0,"10th_percentile":4836.0,"90th_percentile":4836.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":274.87,"10th_percentile":274.87,"90th_percentile":274.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1222.79,"10th_percentile":1222.79,"90th_percentile":1222.79,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":473.61,"10th_percentile":473.61,"90th_percentile":473.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":502.44,"10th_percentile":502.44,"90th_percentile":502.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":4022.04,"10th_percentile":4022.04,"90th_percentile":4022.04,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":7498.0,"10th_percentile":7498.0,"90th_percentile":7498.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":456.21,"10th_percentile":456.21,"90th_percentile":456.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1283.57,"10th_percentile":1283.57,"90th_percentile":1283.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3985.78,"10th_percentile":3985.78,"90th_percentile":3985.78,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":847.6,"10th_percentile":847.6,"90th_percentile":847.6,"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":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2778.08,"10th_percentile":2778.08,"90th_percentile":2778.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"11","median_amount":3035.0,"10th_percentile":2207.33,"90th_percentile":4152.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"14","median_amount":3035.0,"10th_percentile":2560.0,"90th_percentile":4198.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"14","median_amount":336.27,"10th_percentile":293.62,"90th_percentile":665.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"34","median_amount":674.02,"10th_percentile":654.11,"90th_percentile":675.02,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":293.62,"10th_percentile":293.62,"90th_percentile":298.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":532.82,"10th_percentile":523.29,"90th_percentile":532.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":4168.32,"10th_percentile":4168.32,"90th_percentile":7012.12},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":3665.25,"10th_percentile":3665.25,"90th_percentile":3665.25},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":2908.55,"10th_percentile":2321.78,"90th_percentile":8436.18,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":2608.0,"10th_percentile":2608.0,"90th_percentile":2608.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"14","median_amount":7498.0,"10th_percentile":6758.42,"90th_percentile":7775.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"20","median_amount":4982.0,"10th_percentile":4483.8,"90th_percentile":7473.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":640.8,"10th_percentile":640.8,"90th_percentile":640.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"23","median_amount":462.07,"10th_percentile":302.52,"90th_percentile":786.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"73","median_amount":1541.52,"10th_percentile":1141.72,"90th_percentile":1542.72,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":315.77,"10th_percentile":315.77,"90th_percentile":315.77,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":542.59,"10th_percentile":542.59,"90th_percentile":542.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1205.85,"10th_percentile":1205.85,"90th_percentile":1205.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1226.98,"10th_percentile":1226.98,"90th_percentile":1226.98,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":9752.53,"10th_percentile":9752.53,"90th_percentile":9752.53},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":5708.0,"10th_percentile":5708.0,"90th_percentile":5708.0},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"13","median_amount":6796.23,"10th_percentile":4564.33,"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":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":7498.0,"10th_percentile":6391.76,"90th_percentile":14436.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":4982.0,"10th_percentile":4358.86,"90th_percentile":5216.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1285.29,"10th_percentile":1022.09,"90th_percentile":3629.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"40","median_amount":2717.22,"10th_percentile":2298.74,"90th_percentile":2798.74,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3627.21,"10th_percentile":3627.21,"90th_percentile":3627.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2113.39,"10th_percentile":2113.39,"90th_percentile":2113.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2167.38,"10th_percentile":2167.38,"90th_percentile":2167.38,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":18400.02,"10th_percentile":18400.02,"90th_percentile":18400.02},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"1 through 10","median_amount":15587.49,"10th_percentile":15587.49,"90th_percentile":15587.49},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":14186.04,"10th_percentile":14186.04,"90th_percentile":14186.04},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":11701.4,"10th_percentile":11671.36,"90th_percentile":16293.36,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":8246.55,"10th_percentile":8246.55,"90th_percentile":8246.55,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":18738.83,"10th_percentile":18738.83,"90th_percentile":18738.83,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":10188.0,"10th_percentile":9825.0,"90th_percentile":24934.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":6800.2,"10th_percentile":6112.51,"90th_percentile":20347.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1442.3,"10th_percentile":1442.3,"90th_percentile":1442.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":6065.16,"10th_percentile":3580.78,"90th_percentile":6182.23,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2338.23,"10th_percentile":2338.23,"90th_percentile":2338.23,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2319.79,"10th_percentile":2192.36,"90th_percentile":2487.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2835.02,"10th_percentile":2835.02,"90th_percentile":2835.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4938.58,"10th_percentile":4938.58,"90th_percentile":4938.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":12290.95,"10th_percentile":12290.95,"90th_percentile":27104.64,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":25666.51,"10th_percentile":25666.51,"90th_percentile":25666.51,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"1 through 10","median_amount":23405.54,"10th_percentile":23405.54,"90th_percentile":23405.54,"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."}]}]},{"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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":32746.55,"10th_percentile":32746.55,"90th_percentile":32746.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":37235.86,"10th_percentile":27000.11,"90th_percentile":40745.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1621.81,"10th_percentile":1621.81,"90th_percentile":4903.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6181.23,"10th_percentile":6070.67,"90th_percentile":6274.46,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2179.94,"10th_percentile":2179.94,"90th_percentile":2179.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4938.58,"10th_percentile":4938.58,"90th_percentile":4938.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":48463.4,"10th_percentile":48463.4,"90th_percentile":48463.4},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":56629.73,"10th_percentile":56629.73,"90th_percentile":56629.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":44516.61,"10th_percentile":44516.61,"90th_percentile":44516.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16477.3,"10th_percentile":16477.3,"90th_percentile":16477.3,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":28591.2,"10th_percentile":28591.2,"90th_percentile":28591.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":23934.8,"10th_percentile":23934.8,"90th_percentile":23934.8,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":3572.23,"10th_percentile":3572.23,"90th_percentile":3572.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":1899.0,"10th_percentile":1899.0,"90th_percentile":1899.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":5374.81,"10th_percentile":4564.0,"90th_percentile":31815.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":3961.0,"10th_percentile":3961.0,"90th_percentile":3961.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":323.84,"10th_percentile":217.9,"90th_percentile":501.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2641.74,"10th_percentile":2641.74,"90th_percentile":2641.74,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":323.84,"10th_percentile":323.84,"90th_percentile":323.84,"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":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":4085.56,"10th_percentile":4085.56,"90th_percentile":4085.56},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":5279.35,"10th_percentile":5279.35,"90th_percentile":5279.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":4664.0,"10th_percentile":4664.0,"90th_percentile":10659.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":4982.02,"10th_percentile":4694.4,"90th_percentile":5216.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":570.96,"10th_percentile":323.84,"90th_percentile":1050.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1517.75,"10th_percentile":1514.95,"90th_percentile":2605.83,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":888.22,"10th_percentile":888.22,"90th_percentile":888.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":6697.86,"10th_percentile":6697.86,"90th_percentile":6697.86},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":690.9,"10th_percentile":690.9,"90th_percentile":690.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":5886.32,"10th_percentile":5886.32,"90th_percentile":5886.32,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":4033.3,"10th_percentile":4033.3,"90th_percentile":4033.3,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":6328.0,"10th_percentile":6328.0,"90th_percentile":14737.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":6150.16,"10th_percentile":6150.16,"90th_percentile":23009.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1451.3,"10th_percentile":1451.3,"90th_percentile":1451.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"11","median_amount":1436.93,"10th_percentile":952.69,"90th_percentile":2415.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3009.3,"10th_percentile":3009.3,"90th_percentile":3009.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":16731.13,"10th_percentile":16731.13,"90th_percentile":16731.13,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":10347.86,"10th_percentile":10347.86,"90th_percentile":10347.86,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":19286.88,"10th_percentile":19286.88,"90th_percentile":19286.88,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"21","median_amount":21606.0,"10th_percentile":19748.6,"90th_percentile":35650.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"28","median_amount":19855.01,"10th_percentile":19714.57,"90th_percentile":28844.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"47","median_amount":2204.51,"10th_percentile":2175.18,"90th_percentile":4385.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"50","median_amount":6770.26,"10th_percentile":6370.26,"90th_percentile":6771.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3940.7,"10th_percentile":3940.7,"90th_percentile":3940.7,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5320.91,"10th_percentile":5320.91,"90th_percentile":5320.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5409.82,"10th_percentile":5409.82,"90th_percentile":5409.82,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":30474.32,"10th_percentile":30474.32,"90th_percentile":30474.32},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":40077.45,"10th_percentile":39991.02,"90th_percentile":46348.68},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"17","median_amount":22646.4,"10th_percentile":16529.33,"90th_percentile":33901.67,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":21145.01,"10th_percentile":21145.01,"90th_percentile":21145.01,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"14","median_amount":25745.6,"10th_percentile":15684.82,"90th_percentile":62894.72,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Musculoskeletal Procedures","code_information":[{"code":"5115","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"26","median_amount":36844.32,"10th_percentile":29598.62,"90th_percentile":41176.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"37","median_amount":33512.63,"10th_percentile":24228.34,"90th_percentile":39860.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4327.58,"10th_percentile":4327.58,"90th_percentile":4327.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"33","median_amount":4278.13,"10th_percentile":3486.81,"90th_percentile":8809.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"116","median_amount":12281.98,"10th_percentile":11831.98,"90th_percentile":12412.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4171.61,"10th_percentile":4171.61,"90th_percentile":4851.84,"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":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9743.81,"10th_percentile":9743.81,"90th_percentile":9788.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4622.93,"10th_percentile":4622.93,"90th_percentile":4622.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9877.31,"10th_percentile":9877.31,"90th_percentile":9877.31,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"1 through 10","median_amount":59367.85,"10th_percentile":59367.85,"90th_percentile":59367.85},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"21","median_amount":31208.78,"10th_percentile":27961.57,"90th_percentile":35886.18,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":29620.27,"10th_percentile":29620.27,"90th_percentile":29620.27,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":26485.51,"10th_percentile":26485.51,"90th_percentile":45812.46,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 6 Musculoskeletal Procedures","code_information":[{"code":"5116","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":65034.95,"10th_percentile":28256.0,"90th_percentile":87050.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":32123.0,"10th_percentile":20911.37,"90th_percentile":61211.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7212.2,"10th_percentile":4157.46,"90th_percentile":14288.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"30","median_amount":17429.24,"10th_percentile":17336.72,"90th_percentile":17582.93,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13926.45,"10th_percentile":13926.45,"90th_percentile":14661.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":41568.25,"10th_percentile":41568.25,"90th_percentile":85588.16},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":33052.5,"10th_percentile":33052.5,"90th_percentile":33052.5,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":24957.08,"10th_percentile":24957.08,"90th_percentile":24957.08,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":989.03,"10th_percentile":989.03,"90th_percentile":989.03,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3498.07,"10th_percentile":3498.07,"90th_percentile":3498.07,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3098.07,"10th_percentile":3098.07,"90th_percentile":3499.07,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":24716.0,"10th_percentile":24716.0,"90th_percentile":24716.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4184.23,"10th_percentile":4184.23,"90th_percentile":4184.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":16611.49,"10th_percentile":16611.49,"90th_percentile":16611.49,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":15256.01,"10th_percentile":15256.01,"90th_percentile":15256.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":618.63,"10th_percentile":618.63,"90th_percentile":618.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 ENT Procedures","code_information":[{"code":"5162","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":600.0,"10th_percentile":600.0,"90th_percentile":600.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":67.73,"10th_percentile":67.73,"90th_percentile":67.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":77.49,"10th_percentile":77.49,"90th_percentile":77.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 ENT Procedures","code_information":[{"code":"5163","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":846.91,"10th_percentile":846.91,"90th_percentile":846.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2257.83,"10th_percentile":2257.83,"90th_percentile":2257.83,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":5782.87,"10th_percentile":5782.87,"90th_percentile":5782.87,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":10432.0,"10th_percentile":10432.0,"90th_percentile":10432.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":5216.0,"10th_percentile":5216.0,"90th_percentile":5216.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":976.63,"10th_percentile":944.5,"90th_percentile":1962.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":7628.69,"10th_percentile":7628.69,"90th_percentile":7628.69,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":15418.0,"10th_percentile":15314.77,"90th_percentile":23937.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":15253.37,"10th_percentile":13988.85,"90th_percentile":21007.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2106.45,"10th_percentile":944.5,"90th_percentile":2117.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":5607.77,"10th_percentile":5158.77,"90th_percentile":5608.77,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2133.11,"10th_percentile":2133.11,"90th_percentile":2133.11,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2134.1,"10th_percentile":2134.1,"90th_percentile":2134.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":24063.0,"10th_percentile":24063.0,"90th_percentile":24063.0},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":18542.46,"10th_percentile":17025.33,"90th_percentile":41080.11,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"1 through 10","median_amount":14027.03,"10th_percentile":14027.03,"90th_percentile":14027.03},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":26788.37,"10th_percentile":26788.37,"90th_percentile":26788.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"15","median_amount":5563.0,"10th_percentile":5074.5,"90th_percentile":5768.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":4198.0,"10th_percentile":4198.0,"90th_percentile":4198.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"12","median_amount":441.91,"10th_percentile":441.91,"90th_percentile":696.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":593.25,"10th_percentile":144.25,"90th_percentile":1544.19,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":585.25,"10th_percentile":585.25,"90th_percentile":585.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":330.8,"10th_percentile":330.8,"90th_percentile":330.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":2193.78,"10th_percentile":2193.78,"90th_percentile":2193.78,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":7775.0,"10th_percentile":7775.0,"90th_percentile":7775.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"11","median_amount":7016.33,"10th_percentile":5563.0,"90th_percentile":7775.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":5216.0,"10th_percentile":4395.0,"90th_percentile":5216.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":323.02,"10th_percentile":323.02,"90th_percentile":515.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":1470.49,"10th_percentile":1229.49,"90th_percentile":1496.75,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":480.21,"10th_percentile":480.21,"90th_percentile":480.21,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1488.95,"10th_percentile":1488.95,"90th_percentile":1488.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1176.39,"10th_percentile":1176.39,"90th_percentile":1176.39,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":5741.43,"10th_percentile":5741.43,"90th_percentile":5741.43},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":4624.3,"10th_percentile":4624.3,"90th_percentile":10346.36,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":6537.52,"10th_percentile":6537.52,"90th_percentile":6537.52,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"12","median_amount":10085.2,"10th_percentile":9150.4,"90th_percentile":10651.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"13","median_amount":7220.48,"10th_percentile":6746.44,"90th_percentile":15751.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"14","median_amount":1075.31,"10th_percentile":948.8,"90th_percentile":2634.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"39","median_amount":2979.43,"10th_percentile":2620.41,"90th_percentile":2988.43,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3658.1,"10th_percentile":3658.1,"90th_percentile":3658.1,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":959.97,"10th_percentile":959.97,"90th_percentile":959.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4093.64,"10th_percentile":4093.64,"90th_percentile":4093.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2383.54,"10th_percentile":2383.54,"90th_percentile":2383.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":10835.27,"10th_percentile":10835.27,"90th_percentile":10835.27},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":8689.39,"10th_percentile":7467.7,"90th_percentile":13819.94,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":9073.05,"10th_percentile":9073.05,"90th_percentile":9073.05,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":38566.82,"10th_percentile":29439.67,"90th_percentile":40728.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":17971.94,"10th_percentile":13962.0,"90th_percentile":27349.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5148.37,"10th_percentile":4121.06,"90th_percentile":9222.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5126.04,"10th_percentile":5117.04,"90th_percentile":5247.06,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":8881.1,"10th_percentile":8881.1,"90th_percentile":8881.1},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5154.9,"10th_percentile":5154.9,"90th_percentile":5154.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5109.03,"10th_percentile":5109.03,"90th_percentile":5109.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":16361.46,"10th_percentile":16361.46,"90th_percentile":16361.46,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":4505.72,"10th_percentile":4505.72,"90th_percentile":4505.72,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Endovascular Procedures","code_information":[{"code":"5191","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":13693.63,"10th_percentile":13693.63,"90th_percentile":13693.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"20","median_amount":16815.0,"10th_percentile":15262.0,"90th_percentile":17660.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"31","median_amount":17141.0,"10th_percentile":15552.85,"90th_percentile":17722.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"1 through 10","median_amount":900.59,"10th_percentile":900.59,"90th_percentile":900.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"24","median_amount":1158.84,"10th_percentile":1071.23,"90th_percentile":1271.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"145","median_amount":3044.75,"10th_percentile":3029.49,"90th_percentile":3058.44,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1191.44,"10th_percentile":1191.44,"90th_percentile":1191.44,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"13","median_amount":1153.9,"10th_percentile":1101.6,"90th_percentile":1400.98,"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":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2434.1,"10th_percentile":2423.6,"90th_percentile":2446.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1098.3,"10th_percentile":1098.3,"90th_percentile":1098.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2435.72,"10th_percentile":2435.72,"90th_percentile":2435.72,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":16868.71,"10th_percentile":16014.26,"90th_percentile":33809.31},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":18842.85,"10th_percentile":16691.0,"90th_percentile":19732.31},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"20","median_amount":17834.48,"10th_percentile":13779.44,"90th_percentile":22502.72,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Endovascular Procedures","code_information":[{"code":"5192","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":18367.01,"10th_percentile":18367.01,"90th_percentile":18367.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":21885.47,"10th_percentile":21885.47,"90th_percentile":21885.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":5405.07,"10th_percentile":5313.86,"90th_percentile":5716.66,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3720.39,"10th_percentile":3720.39,"90th_percentile":3720.39,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4317.65,"10th_percentile":4317.65,"90th_percentile":4317.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":18112.92,"10th_percentile":18112.92,"90th_percentile":19434.06,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":33080.13,"10th_percentile":33080.13,"90th_percentile":33080.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"11","median_amount":37146.97,"10th_percentile":24222.48,"90th_percentile":40789.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"15","median_amount":37233.65,"10th_percentile":26880.0,"90th_percentile":47205.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"12","median_amount":4965.84,"10th_percentile":3840.97,"90th_percentile":7507.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"54","median_amount":10735.0,"10th_percentile":10227.8,"90th_percentile":16556.85,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":4481.19,"10th_percentile":4481.19,"90th_percentile":4481.19,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7394.44,"10th_percentile":7394.44,"90th_percentile":7394.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8587.99,"10th_percentile":8587.99,"90th_percentile":9305.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8587.99,"10th_percentile":8587.99,"90th_percentile":8587.99,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":62696.47,"10th_percentile":62696.47,"90th_percentile":62696.47},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6512.62,"10th_percentile":6512.62,"90th_percentile":6512.62,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":32435.55,"10th_percentile":28110.85,"90th_percentile":74345.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":28763.6,"10th_percentile":26422.8,"90th_percentile":28939.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":6618.67,"10th_percentile":6618.67,"90th_percentile":6673.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17005.85,"10th_percentile":17005.85,"90th_percentile":17006.85,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":95541.6,"10th_percentile":95541.6,"90th_percentile":95541.6,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Electrophysiologic Procedures","code_information":[{"code":"5212","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":41731.44,"10th_percentile":41731.44,"90th_percentile":41731.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Electrophysiologic Procedures","code_information":[{"code":"5213","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"14","median_amount":53408.0,"10th_percentile":53408.0,"90th_percentile":56852.14,"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":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"12","median_amount":54443.0,"10th_percentile":54442.99,"90th_percentile":55320.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9056.19,"10th_percentile":9056.19,"90th_percentile":9056.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"15","median_amount":8978.02,"10th_percentile":7662.74,"90th_percentile":12651.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"33","median_amount":23222.52,"10th_percentile":22080.8,"90th_percentile":23222.82,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":7464.58,"10th_percentile":7464.58,"90th_percentile":7464.58,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":12621.96,"10th_percentile":12621.96,"90th_percentile":12621.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18577.85,"10th_percentile":18577.85,"90th_percentile":18577.85,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":57465.0,"10th_percentile":57465.0,"90th_percentile":67843.73},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":88220.54,"10th_percentile":88220.54,"90th_percentile":88220.54},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":81346.05,"10th_percentile":46048.52,"90th_percentile":97485.5,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":100027.91,"10th_percentile":100027.91,"90th_percentile":100027.91,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Pacemaker and Similar Procedures","code_information":[{"code":"5222","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":27295.5,"10th_percentile":27295.5,"90th_percentile":28163.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3462.17,"10th_percentile":3443.72,"90th_percentile":3462.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7834.05,"10th_percentile":7834.05,"90th_percentile":7898.45,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":25065.74,"10th_percentile":25065.74,"90th_percentile":25065.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":9962.95,"10th_percentile":9906.5,"90th_percentile":10030.87,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3477.6,"10th_percentile":3477.6,"90th_percentile":3477.6,"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":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":51001.99,"10th_percentile":51001.99,"90th_percentile":51001.99},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Pacemaker and Similar Procedures","code_information":[{"code":"5224","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":32427.53,"10th_percentile":32427.53,"90th_percentile":32427.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18124.63,"10th_percentile":18124.63,"90th_percentile":18124.63,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 ICD and Similar Procedures","code_information":[{"code":"5231","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":13348.59,"10th_percentile":13348.59,"90th_percentile":33499.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":21247.6,"10th_percentile":21247.6,"90th_percentile":21914.4,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9817.38,"10th_percentile":9817.38,"90th_percentile":9817.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17531.51,"10th_percentile":17531.51,"90th_percentile":17531.51,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":56486.61,"10th_percentile":56486.61,"90th_percentile":56486.61,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 ICD and Similar Procedures","code_information":[{"code":"5232","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":59702.23,"10th_percentile":59702.23,"90th_percentile":59702.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":38320.15,"10th_percentile":32520.13,"90th_percentile":51043.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9787.19,"10th_percentile":3528.73,"90th_percentile":12345.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":30445.19,"10th_percentile":30349.54,"90th_percentile":30586.36,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":24670.1,"10th_percentile":24670.1,"90th_percentile":24670.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":123865.37,"10th_percentile":123865.37,"90th_percentile":123865.37},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":80497.13,"10th_percentile":80497.13,"90th_percentile":80497.13,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":3005.85,"10th_percentile":3005.85,"90th_percentile":3005.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":3960.98,"10th_percentile":3960.98,"90th_percentile":4856.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1152.84,"10th_percentile":720.96,"90th_percentile":1508.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"36","median_amount":664.51,"10th_percentile":592.19,"90th_percentile":932.7,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":710.32,"10th_percentile":320.44,"90th_percentile":1148.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":497.8,"10th_percentile":497.8,"90th_percentile":497.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":2528.26,"10th_percentile":2452.03,"90th_percentile":8174.6,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":8344.5,"10th_percentile":8344.5,"90th_percentile":8344.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"12","median_amount":4450.38,"10th_percentile":3252.8,"90th_percentile":8344.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"12","median_amount":4198.0,"10th_percentile":1997.53,"90th_percentile":4198.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"76","median_amount":387.52,"10th_percentile":322.12,"90th_percentile":448.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"49","median_amount":887.5,"10th_percentile":494.95,"90th_percentile":1266.91,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":415.88,"10th_percentile":376.39,"90th_percentile":439.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":674.21,"10th_percentile":674.21,"90th_percentile":674.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1470.4,"10th_percentile":1470.4,"90th_percentile":1470.4,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"13","median_amount":9536.39,"10th_percentile":6562.11,"90th_percentile":11247.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":4982.01,"10th_percentile":3933.54,"90th_percentile":8614.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"22","median_amount":448.47,"10th_percentile":430.99,"90th_percentile":1178.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"31","median_amount":1803.69,"10th_percentile":1403.69,"90th_percentile":1804.69,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1324.86,"10th_percentile":1324.86,"90th_percentile":1324.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1436.55,"10th_percentile":1436.55,"90th_percentile":1436.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1436.55,"10th_percentile":1436.55,"90th_percentile":1769.06,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":7487.45,"10th_percentile":7487.45,"90th_percentile":7487.45},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1822.13,"10th_percentile":1822.13,"90th_percentile":1822.13,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":7424.76,"10th_percentile":6188.17,"90th_percentile":8337.52,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":9483.69,"10th_percentile":5938.45,"90th_percentile":10464.21,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":1354.69,"10th_percentile":1354.69,"90th_percentile":1354.69,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":9065.97,"10th_percentile":9065.97,"90th_percentile":15226.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2387.57,"10th_percentile":2365.54,"90th_percentile":3151.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":3609.37,"10th_percentile":3567.54,"90th_percentile":3610.37,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":24149.29,"10th_percentile":24149.29,"90th_percentile":33288.02},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":17443.64,"10th_percentile":17443.64,"90th_percentile":17443.64,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":5563.0,"10th_percentile":5563.0,"90th_percentile":5767.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":4198.0,"10th_percentile":4198.0,"90th_percentile":4198.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":431.32,"10th_percentile":431.32,"90th_percentile":431.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1285.26,"10th_percentile":1285.26,"90th_percentile":1285.26,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":690.42,"10th_percentile":690.42,"90th_percentile":690.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":7498.0,"10th_percentile":4664.0,"90th_percentile":10105.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":4982.0,"10th_percentile":4982.0,"90th_percentile":7498.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":876.39,"10th_percentile":440.12,"90th_percentile":1648.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"23","median_amount":1116.12,"10th_percentile":1097.11,"90th_percentile":2126.92,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1637.29,"10th_percentile":1637.29,"90th_percentile":1637.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":892.9,"10th_percentile":892.9,"90th_percentile":1345.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":483.24,"10th_percentile":483.24,"90th_percentile":483.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1339.35,"10th_percentile":1339.35,"90th_percentile":1971.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":9077.88,"10th_percentile":9077.88,"90th_percentile":27119.34},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":7176.99,"10th_percentile":6275.91,"90th_percentile":7552.09,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":6836.29,"10th_percentile":6836.29,"90th_percentile":6836.29,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":9536.29,"10th_percentile":9536.29,"90th_percentile":13221.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":5859.75,"10th_percentile":5859.75,"90th_percentile":5859.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":944.12,"10th_percentile":944.12,"90th_percentile":944.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2604.95,"10th_percentile":2595.95,"90th_percentile":2735.83,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":3873.87,"10th_percentile":3873.87,"90th_percentile":3873.87,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex GI Procedures","code_information":[{"code":"5331","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":19632.56,"10th_percentile":19632.56,"90th_percentile":30378.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":17577.42,"10th_percentile":17577.42,"90th_percentile":21404.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3428.3,"10th_percentile":3428.3,"90th_percentile":3428.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5634.94,"10th_percentile":5193.94,"90th_percentile":5643.94,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5634.94,"10th_percentile":5634.94,"90th_percentile":5634.94,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":23269.84,"10th_percentile":23269.84,"90th_percentile":23269.84},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":10656.44,"10th_percentile":10656.44,"90th_percentile":10656.44,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":9930.65,"10th_percentile":8192.15,"90th_percentile":19349.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":8159.4,"10th_percentile":6044.0,"90th_percentile":15316.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1418.32,"10th_percentile":863.69,"90th_percentile":1951.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":3346.91,"10th_percentile":3216.46,"90th_percentile":5642.74,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1144.87,"10th_percentile":1144.87,"90th_percentile":1144.87,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":7117.62,"10th_percentile":7117.62,"90th_percentile":7117.62},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":5004.38,"10th_percentile":5004.38,"90th_percentile":9755.47},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":12059.07,"10th_percentile":5187.65,"90th_percentile":28138.9,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":21924.68,"10th_percentile":21924.68,"90th_percentile":21924.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":18108.88,"10th_percentile":18108.88,"90th_percentile":18108.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":9039.64,"10th_percentile":9039.64,"90th_percentile":9039.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3143.79,"10th_percentile":3143.79,"90th_percentile":3143.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":19413.0,"10th_percentile":19413.0,"90th_percentile":22611.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"31","median_amount":22413.0,"10th_percentile":18905.03,"90th_percentile":29184.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"52","median_amount":22370.0,"10th_percentile":20584.54,"90th_percentile":31755.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"76","median_amount":1939.08,"10th_percentile":1599.83,"90th_percentile":2921.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"37","median_amount":5530.82,"10th_percentile":5371.36,"90th_percentile":7276.54,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2629.78,"10th_percentile":2629.78,"90th_percentile":2629.78,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":865.94,"10th_percentile":865.94,"90th_percentile":2146.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4418.25,"10th_percentile":4418.25,"90th_percentile":4418.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4418.25,"10th_percentile":4418.25,"90th_percentile":4418.25,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":29020.03,"10th_percentile":21410.25,"90th_percentile":30446.31},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"1 through 10","median_amount":5323.24,"10th_percentile":5323.24,"90th_percentile":5323.24},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2108.01,"10th_percentile":2108.01,"90th_percentile":2108.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":30126.96,"10th_percentile":26977.84,"90th_percentile":47645.64},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"31","median_amount":23782.45,"10th_percentile":16694.26,"90th_percentile":30362.49,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":25036.83,"10th_percentile":20161.33,"90th_percentile":40122.15,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":19273.59,"10th_percentile":19273.59,"90th_percentile":19273.59,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Laparoscopy and Related Services","code_information":[{"code":"5362","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"22","median_amount":23868.93,"10th_percentile":21300.43,"90th_percentile":40464.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"34","median_amount":26874.84,"10th_percentile":20778.0,"90th_percentile":35000.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"14","median_amount":858.96,"10th_percentile":30.45,"90th_percentile":3432.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"25","median_amount":9855.28,"10th_percentile":9414.28,"90th_percentile":9864.28,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2591.21,"10th_percentile":2591.21,"90th_percentile":2591.21,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3437.02,"10th_percentile":3437.02,"90th_percentile":3437.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2607.84,"10th_percentile":2607.84,"90th_percentile":2607.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7886.39,"10th_percentile":7886.39,"90th_percentile":7886.39,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":26234.87,"10th_percentile":22205.86,"90th_percentile":39010.17},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"18","median_amount":28110.75,"10th_percentile":22600.99,"90th_percentile":38660.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":23086.39,"10th_percentile":23086.39,"90th_percentile":24030.65,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":2250.37,"10th_percentile":2250.37,"90th_percentile":2250.37,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":4395.0,"10th_percentile":4395.0,"90th_percentile":4395.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":1109.05,"10th_percentile":1109.05,"90th_percentile":1109.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":631.83,"10th_percentile":631.83,"90th_percentile":631.83,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":2276.55,"10th_percentile":2276.55,"90th_percentile":2276.55,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":4837.76,"10th_percentile":4824.66,"90th_percentile":4982.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":789.2,"10th_percentile":691.11,"90th_percentile":2003.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1941.63,"10th_percentile":1771.13,"90th_percentile":1948.13,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1551.3,"10th_percentile":1551.3,"90th_percentile":1551.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":7295.36,"10th_percentile":7295.36,"90th_percentile":7295.36},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":15798.08,"10th_percentile":12998.2,"90th_percentile":20582.26,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"15","median_amount":9825.0,"10th_percentile":6044.0,"90th_percentile":15254.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":8535.0,"10th_percentile":5439.6,"90th_percentile":10044.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"18","median_amount":1058.26,"10th_percentile":690.81,"90th_percentile":1898.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"31","median_amount":3267.0,"10th_percentile":2898.09,"90th_percentile":3273.8,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1064.74,"10th_percentile":1064.74,"90th_percentile":1064.74,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":687.81,"10th_percentile":687.81,"90th_percentile":687.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":983.93,"10th_percentile":983.93,"90th_percentile":983.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2611.84,"10th_percentile":2611.84,"90th_percentile":9270.04,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":14271.54,"10th_percentile":14271.54,"90th_percentile":14271.54},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":706.57,"10th_percentile":706.57,"90th_percentile":706.57,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":14680.4,"10th_percentile":14680.4,"90th_percentile":14680.4},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":9617.01,"10th_percentile":8723.23,"90th_percentile":14717.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":11729.66,"10th_percentile":11729.66,"90th_percentile":11729.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":17766.33,"10th_percentile":17766.33,"90th_percentile":17766.33,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"26","median_amount":15110.0,"10th_percentile":13851.75,"90th_percentile":21380.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"17","median_amount":14894.05,"10th_percentile":13962.0,"90th_percentile":21007.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"14","median_amount":1979.02,"10th_percentile":1833.46,"90th_percentile":2490.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"91","median_amount":4820.16,"10th_percentile":4605.53,"90th_percentile":4844.28,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1855.28,"10th_percentile":1855.28,"90th_percentile":2375.85,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2482.92,"10th_percentile":2482.92,"90th_percentile":2482.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3849.73,"10th_percentile":3849.73,"90th_percentile":3849.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3849.73,"10th_percentile":3849.73,"90th_percentile":19562.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":20915.22,"10th_percentile":20915.22,"90th_percentile":20915.22},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":18848.49,"10th_percentile":18848.49,"90th_percentile":18848.49},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"15","median_amount":13029.92,"10th_percentile":11390.1,"90th_percentile":21504.55,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 6 Urology and Related Services","code_information":[{"code":"5376","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":33666.58,"10th_percentile":33666.58,"90th_percentile":33666.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":3769.09,"10th_percentile":3769.09,"90th_percentile":3769.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8761.17,"10th_percentile":8761.17,"90th_percentile":8761.17,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 7 Urology and Related Services","code_information":[{"code":"5377","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":2623.07,"10th_percentile":2623.07,"90th_percentile":2623.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1968.25,"10th_percentile":1968.25,"90th_percentile":1968.25,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"75","median_amount":1483.9,"10th_percentile":1181.76,"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":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"65","median_amount":1394.19,"10th_percentile":1072.4,"90th_percentile":2308.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":193.22,"10th_percentile":193.22,"90th_percentile":193.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":303.09,"10th_percentile":303.09,"90th_percentile":303.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"260","median_amount":114.5,"10th_percentile":86.42,"90th_percentile":359.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":299.06,"10th_percentile":299.06,"90th_percentile":299.06,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"12","median_amount":89.7,"10th_percentile":86.42,"90th_percentile":374.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"11","median_amount":1954.56,"10th_percentile":609.02,"90th_percentile":3045.12},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":175.28,"10th_percentile":147.48,"90th_percentile":400.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":20114.59,"10th_percentile":20114.59,"90th_percentile":20114.59},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"30","median_amount":1560.56,"10th_percentile":1349.15,"90th_percentile":2352.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":1577.03,"10th_percentile":1577.03,"90th_percentile":1577.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","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":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":195.62,"10th_percentile":195.62,"90th_percentile":195.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Gynecologic Procedures","code_information":[{"code":"5413","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":3745.5,"10th_percentile":3745.5,"90th_percentile":3745.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":258.7,"10th_percentile":258.7,"90th_percentile":258.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":659.4,"10th_percentile":659.4,"90th_percentile":659.4,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":7775.0,"10th_percentile":7775.0,"90th_percentile":7775.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":4982.0,"10th_percentile":4732.65,"90th_percentile":6265.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1692.27,"10th_percentile":1692.27,"90th_percentile":1692.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"18","median_amount":796.35,"10th_percentile":363.37,"90th_percentile":1470.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2913.58,"10th_percentile":2913.58,"90th_percentile":2913.58,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":777.93,"10th_percentile":777.93,"90th_percentile":777.93,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1037.45,"10th_percentile":1037.45,"90th_percentile":1037.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2407.8,"10th_percentile":2407.8,"90th_percentile":2407.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":17755.21,"10th_percentile":17755.21,"90th_percentile":18872.24},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":11976.4,"10th_percentile":11976.4,"90th_percentile":11976.4},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":15562.27,"10th_percentile":13553.89,"90th_percentile":16782.77,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":31575.82,"10th_percentile":31575.82,"90th_percentile":31575.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":29145.92,"10th_percentile":29145.92,"90th_percentile":29145.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1999.33,"10th_percentile":1999.33,"90th_percentile":1999.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4680.66,"10th_percentile":4232.26,"90th_percentile":4681.86,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":12691.51,"10th_percentile":12691.51,"90th_percentile":12691.51,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":36914.0,"10th_percentile":36914.0,"90th_percentile":36914.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":27759.0,"10th_percentile":19114.66,"90th_percentile":31481.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1897.31,"10th_percentile":1897.31,"90th_percentile":1897.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7008.93,"10th_percentile":7007.93,"90th_percentile":7032.33,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5599.95,"10th_percentile":5599.95,"90th_percentile":5599.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":23664.86,"10th_percentile":22840.32,"90th_percentile":26150.59,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":17482.14,"10th_percentile":17482.14,"90th_percentile":17482.14,"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":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":11611.56,"10th_percentile":11611.56,"90th_percentile":11611.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":974.99,"10th_percentile":843.34,"90th_percentile":2165.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1802.05,"10th_percentile":1407.5,"90th_percentile":1856.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":963.09,"10th_percentile":963.09,"90th_percentile":963.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1478.8,"10th_percentile":1478.8,"90th_percentile":1649.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":18268.82,"10th_percentile":18268.82,"90th_percentile":18268.82,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nerve Procedures","code_information":[{"code":"5432","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":14245.12,"10th_percentile":14245.12,"90th_percentile":14245.12,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":2279.4,"10th_percentile":2279.4,"90th_percentile":2279.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":234.29,"10th_percentile":183.64,"90th_percentile":448.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":293.93,"10th_percentile":293.93,"90th_percentile":293.93,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":234.29,"10th_percentile":234.29,"90th_percentile":234.29,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":2804.4,"10th_percentile":2804.4,"90th_percentile":2804.4},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nerve Injections","code_information":[{"code":"5442","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":7528.7,"10th_percentile":5563.0,"90th_percentile":14867.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":3961.0,"10th_percentile":3279.85,"90th_percentile":8557.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"13","median_amount":370.02,"10th_percentile":195.18,"90th_percentile":1615.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":663.54,"10th_percentile":649.93,"90th_percentile":752.14,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1978.71,"10th_percentile":1978.71,"90th_percentile":1978.71,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":34169.92,"10th_percentile":34169.92,"90th_percentile":34169.92},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":3952.0,"10th_percentile":3368.01,"90th_percentile":7542.55,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":976.5,"10th_percentile":976.5,"90th_percentile":976.5,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":5057.76,"10th_percentile":5057.76,"90th_percentile":5057.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Nerve Injections","code_information":[{"code":"5443","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"20","median_amount":5563.0,"10th_percentile":4864.68,"90th_percentile":8652.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"34","median_amount":4198.0,"10th_percentile":3797.58,"90th_percentile":7773.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"36","median_amount":333.82,"10th_percentile":333.82,"90th_percentile":667.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"53","median_amount":850.75,"10th_percentile":401.75,"90th_percentile":1178.52,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":501.51,"10th_percentile":501.51,"90th_percentile":501.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1011.3,"10th_percentile":1011.3,"90th_percentile":1264.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":5641.72,"10th_percentile":4783.97,"90th_percentile":5643.65},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":4746.76,"10th_percentile":4367.75,"90th_percentile":6861.38,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":4007.84,"10th_percentile":3960.23,"90th_percentile":7032.94,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":7836.87,"10th_percentile":5248.55,"90th_percentile":14578.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"1 through 10","median_amount":3831.51,"10th_percentile":3831.51,"90th_percentile":3831.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":51388.5,"10th_percentile":51388.5,"90th_percentile":51388.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9842.09,"10th_percentile":9842.09,"90th_percentile":9842.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Neurostimulator and Related Procedures","code_information":[{"code":"5465","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":65934.53,"10th_percentile":65934.53,"90th_percentile":65934.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"26","median_amount":237.0,"10th_percentile":137.0,"90th_percentile":3961.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"30","median_amount":1229.42,"10th_percentile":137.0,"90th_percentile":3961.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":178.45,"10th_percentile":178.45,"90th_percentile":178.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":183.59,"10th_percentile":183.59,"90th_percentile":183.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"71","median_amount":139.0,"10th_percentile":46.58,"90th_percentile":336.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"56","median_amount":85.05,"10th_percentile":85.05,"90th_percentile":684.15,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":142.16,"10th_percentile":142.16,"90th_percentile":221.07,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":224.32,"10th_percentile":104.38,"90th_percentile":683.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":696.73,"10th_percentile":696.73,"90th_percentile":696.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":300.8,"10th_percentile":300.8,"90th_percentile":300.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":530.97,"10th_percentile":389.15,"90th_percentile":883.91,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"1 through 10","median_amount":119.19,"10th_percentile":119.19,"90th_percentile":119.19},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":113.7,"10th_percentile":36.49,"90th_percentile":234.68,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":2551.21,"10th_percentile":2551.21,"90th_percentile":2865.6},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"17","median_amount":110.16,"10th_percentile":104.81,"90th_percentile":2514.33,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":143.36,"10th_percentile":143.36,"90th_percentile":1330.45,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":3165.84,"10th_percentile":2364.76,"90th_percentile":4283.03,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"537","median_amount":1437.67,"10th_percentile":1171.0,"90th_percentile":2606.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"530","median_amount":1273.0,"10th_percentile":971.0,"90th_percentile":2474.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":704.28,"10th_percentile":704.28,"90th_percentile":704.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":44.19,"10th_percentile":44.19,"90th_percentile":366.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1377","median_amount":65.62,"10th_percentile":43.75,"90th_percentile":80.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"35","median_amount":104.3,"10th_percentile":100.67,"90th_percentile":879.08,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"17","median_amount":64.63,"10th_percentile":43.74,"90th_percentile":66.11,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"86","median_amount":65.62,"10th_percentile":43.75,"90th_percentile":131.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":80.54,"10th_percentile":80.54,"90th_percentile":80.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":253.31,"10th_percentile":253.31,"90th_percentile":253.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":80.54,"10th_percentile":80.54,"90th_percentile":766.87,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"43","median_amount":1932.48,"10th_percentile":1124.16,"90th_percentile":2543.04},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":2681.08,"10th_percentile":2681.08,"90th_percentile":2681.08},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":36.48,"10th_percentile":36.48,"90th_percentile":36.48,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":1509.75,"10th_percentile":1013.25,"90th_percentile":25503.94},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"210","median_amount":1416.02,"10th_percentile":782.6,"90th_percentile":2509.97,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"35","median_amount":1467.84,"10th_percentile":648.99,"90th_percentile":2094.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"1 through 10","median_amount":16392.5,"10th_percentile":16392.5,"90th_percentile":16392.5},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":6300.49,"10th_percentile":4491.28,"90th_percentile":21395.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"1 through 10","median_amount":1373.44,"10th_percentile":1373.44,"90th_percentile":1688.79,"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."}]}]},{"description":"Level 3 Imaging without Contrast","code_information":[{"code":"5523","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":1216.0,"10th_percentile":1216.0,"90th_percentile":1216.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"141","median_amount":1303.0,"10th_percentile":1142.4,"90th_percentile":3301.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"133","median_amount":1216.0,"10th_percentile":972.8,"90th_percentile":3673.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":227.04,"10th_percentile":227.04,"90th_percentile":227.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":44.52,"10th_percentile":44.52,"90th_percentile":66.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"331","median_amount":65.62,"10th_percentile":43.75,"90th_percentile":112.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"53","median_amount":232.31,"10th_percentile":198.41,"90th_percentile":381.81,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":65.6,"10th_percentile":43.09,"90th_percentile":874.52,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"16","median_amount":72.27,"10th_percentile":43.75,"90th_percentile":209.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":183.04,"10th_percentile":183.04,"90th_percentile":1171.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":183.08,"10th_percentile":183.04,"90th_percentile":409.14,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"16","median_amount":3668.16,"10th_percentile":1418.88,"90th_percentile":6540.48},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":2798.04,"10th_percentile":2798.04,"90th_percentile":2798.04},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"63","median_amount":2923.07,"10th_percentile":2104.52,"90th_percentile":4239.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"12","median_amount":2624.04,"10th_percentile":1710.36,"90th_percentile":3030.05,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"27","median_amount":2966.4,"10th_percentile":2472.3,"90th_percentile":3418.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"23","median_amount":2925.05,"10th_percentile":1442.05,"90th_percentile":6883.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"31","median_amount":3739.99,"10th_percentile":900.67,"90th_percentile":5741.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"35","median_amount":146.02,"10th_percentile":124.27,"90th_percentile":470.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"97","median_amount":519.02,"10th_percentile":509.22,"90th_percentile":532.24,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":458.47,"10th_percentile":124.97,"90th_percentile":778.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":410.32,"10th_percentile":410.32,"90th_percentile":634.52,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":3464.11,"10th_percentile":1299.38,"90th_percentile":11976.96},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":9900.41,"10th_percentile":9900.41,"90th_percentile":9900.41},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"15","median_amount":4279.43,"10th_percentile":2669.09,"90th_percentile":4772.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"1 through 10","median_amount":25.0,"10th_percentile":25.0,"90th_percentile":25.0,"additional_payer_notes":"Contracting method is an algorithm described in 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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"18","median_amount":3262.25,"10th_percentile":2606.61,"90th_percentile":3646.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":620.95,"10th_percentile":620.95,"90th_percentile":620.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"41","median_amount":174.3,"10th_percentile":171.95,"90th_percentile":415.38,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":403.29,"10th_percentile":403.29,"90th_percentile":403.29,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":162.56,"10th_percentile":162.56,"90th_percentile":162.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":333.79,"10th_percentile":333.79,"90th_percentile":333.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":522.05,"10th_percentile":522.05,"90th_percentile":522.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":202.21,"10th_percentile":202.21,"90th_percentile":202.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":5662.08,"10th_percentile":5662.08,"90th_percentile":5662.08},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":4453.72,"10th_percentile":4321.91,"90th_percentile":7866.41,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":6532.1,"10th_percentile":6532.1,"90th_percentile":6532.1,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"1 through 10","median_amount":4606.78,"10th_percentile":4606.78,"90th_percentile":4606.78,"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."}]}]},{"description":"Level 2 Imaging with Contrast","code_information":[{"code":"5572","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":3369.93,"10th_percentile":3369.93,"90th_percentile":3369.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"35","median_amount":4543.24,"10th_percentile":1575.0,"90th_percentile":5985.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"34","median_amount":3489.87,"10th_percentile":1364.0,"90th_percentile":4661.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":339.01,"10th_percentile":339.01,"90th_percentile":339.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"84","median_amount":176.37,"10th_percentile":172.89,"90th_percentile":363.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"88","median_amount":343.06,"10th_percentile":301.93,"90th_percentile":812.69,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":345.7,"10th_percentile":345.7,"90th_percentile":345.7,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":178.15,"10th_percentile":176.37,"90th_percentile":352.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":439.65,"10th_percentile":270.95,"90th_percentile":1118.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":281.98,"10th_percentile":281.98,"90th_percentile":281.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1307.91,"10th_percentile":405.26,"90th_percentile":2156.64,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"11","median_amount":5388.67,"10th_percentile":243.22,"90th_percentile":13968.43},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":4868.57,"10th_percentile":4868.57,"90th_percentile":4868.57},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"1 through 10","median_amount":424.92,"10th_percentile":424.92,"90th_percentile":424.92},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":444.66,"10th_percentile":444.66,"90th_percentile":444.66,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":3515.52,"10th_percentile":3515.52,"90th_percentile":7431.92},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"21","median_amount":4330.69,"10th_percentile":2371.52,"90th_percentile":6100.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":1221.41,"10th_percentile":1221.41,"90th_percentile":3444.7,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":6937.29,"10th_percentile":6937.29,"90th_percentile":6937.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"1 through 10","median_amount":4724.58,"10th_percentile":4724.58,"90th_percentile":4724.58,"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":"Level 3 Imaging with Contrast","code_information":[{"code":"5573","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":6037.85,"10th_percentile":5086.75,"90th_percentile":6256.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":6043.85,"10th_percentile":5993.55,"90th_percentile":6140.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"14","median_amount":417.12,"10th_percentile":377.77,"90th_percentile":417.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1094.93,"10th_percentile":719.93,"90th_percentile":1503.22,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":5810.88,"10th_percentile":5810.88,"90th_percentile":5810.88},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":13961.98,"10th_percentile":13961.98,"90th_percentile":13961.98},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":4469.2,"10th_percentile":4469.2,"90th_percentile":4733.38,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":5019.21,"10th_percentile":4736.21,"90th_percentile":5323.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":1815.0,"10th_percentile":1815.0,"90th_percentile":1815.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":385.21,"10th_percentile":385.21,"90th_percentile":385.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":397.98,"10th_percentile":397.98,"90th_percentile":400.24,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":2843.4,"10th_percentile":2843.4,"90th_percentile":2843.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":402.02,"10th_percentile":402.02,"90th_percentile":402.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":321.68,"10th_percentile":161.5,"90th_percentile":422.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":513.03,"10th_percentile":506.01,"90th_percentile":1791.87,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":398.03,"10th_percentile":398.03,"90th_percentile":398.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":2712.96,"10th_percentile":2712.96,"90th_percentile":2712.96},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":2749.41,"10th_percentile":2749.41,"90th_percentile":2749.41,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":2016.92,"10th_percentile":2016.92,"90th_percentile":2016.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":11416.43,"10th_percentile":11416.43,"90th_percentile":11416.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":6040.97,"10th_percentile":6040.97,"90th_percentile":6040.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":402.02,"10th_percentile":402.02,"90th_percentile":402.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":398.03,"10th_percentile":398.03,"90th_percentile":398.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2552.48,"10th_percentile":1573.8,"90th_percentile":2606.58,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":4039.5,"10th_percentile":4039.5,"90th_percentile":4039.5},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":5434.02,"10th_percentile":5434.02,"90th_percentile":5434.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Nuclear Medicine and Related Services","code_information":[{"code":"5594","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"27","median_amount":6017.79,"10th_percentile":6007.79,"90th_percentile":19051.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"21","median_amount":5563.69,"10th_percentile":2117.77,"90th_percentile":14810.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"15","median_amount":610.53,"10th_percentile":610.53,"90th_percentile":613.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"127","median_amount":1454.48,"10th_percentile":1380.7,"90th_percentile":7505.3,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":610.39,"10th_percentile":610.39,"90th_percentile":610.39,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":610.53,"10th_percentile":583.93,"90th_percentile":610.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1163.58,"10th_percentile":1104.56,"90th_percentile":1193.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1454.48,"10th_percentile":1163.58,"90th_percentile":1454.48,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":9510.72,"10th_percentile":9510.72,"90th_percentile":9510.72},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":610.53,"10th_percentile":610.53,"90th_percentile":610.53,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"19","median_amount":7578.86,"10th_percentile":6680.8,"90th_percentile":21936.7,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Therapeutic Nuclear Medicine","code_information":[{"code":"5661","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":851.53,"10th_percentile":851.53,"90th_percentile":851.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":47291.36,"10th_percentile":44337.76,"90th_percentile":47291.36,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":125.0,"10th_percentile":106.25,"90th_percentile":250.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"12","median_amount":125.0,"10th_percentile":125.0,"90th_percentile":138.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":26.02,"10th_percentile":26.02,"90th_percentile":52.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"466","median_amount":25.76,"10th_percentile":19.91,"90th_percentile":77.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1483","median_amount":50.78,"10th_percentile":45.68,"90th_percentile":50.98,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"23","median_amount":30.02,"10th_percentile":25.76,"90th_percentile":61.79,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"51","median_amount":30.02,"10th_percentile":25.76,"90th_percentile":81.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"32","median_amount":47.59,"10th_percentile":40.46,"90th_percentile":50.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":51.52,"10th_percentile":51.52,"90th_percentile":51.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"27","median_amount":40.46,"10th_percentile":40.31,"90th_percentile":53.29,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":93.75,"10th_percentile":93.75,"90th_percentile":93.75},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":95.63,"10th_percentile":95.63,"90th_percentile":382.5,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":471.0,"10th_percentile":471.0,"90th_percentile":471.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":1015.0,"10th_percentile":447.0,"90th_percentile":1483.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":666.51,"10th_percentile":666.51,"90th_percentile":666.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":489.48,"10th_percentile":489.48,"90th_percentile":489.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"130","median_amount":89.06,"10th_percentile":37.54,"90th_percentile":164.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"273","median_amount":162.41,"10th_percentile":158.8,"90th_percentile":162.61,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":72.17,"10th_percentile":72.17,"90th_percentile":72.17,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"12","median_amount":75.08,"10th_percentile":58.77,"90th_percentile":232.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":159.87,"10th_percentile":159.45,"90th_percentile":162.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":66.47,"10th_percentile":66.47,"90th_percentile":66.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":129.77,"10th_percentile":127.04,"90th_percentile":162.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":511.68,"10th_percentile":511.68,"90th_percentile":511.68},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":256.0,"10th_percentile":256.0,"90th_percentile":22413.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":1428.0,"10th_percentile":216.1,"90th_percentile":22484.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":42.5,"10th_percentile":42.5,"90th_percentile":42.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":138.69,"10th_percentile":138.69,"90th_percentile":138.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"63","median_amount":126.36,"10th_percentile":40.64,"90th_percentile":686.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"151","median_amount":340.91,"10th_percentile":334.18,"90th_percentile":397.54,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":75.27,"10th_percentile":65.73,"90th_percentile":160.38,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"11","median_amount":128.68,"10th_percentile":112.1,"90th_percentile":270.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":330.24,"10th_percentile":274.99,"90th_percentile":374.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":272.41,"10th_percentile":272.41,"90th_percentile":303.36,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":38885.1,"10th_percentile":38885.1,"90th_percentile":38885.1,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1051.69,"10th_percentile":1051.69,"90th_percentile":1051.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":787.04,"10th_percentile":773.68,"90th_percentile":3634.49,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":39848.05,"10th_percentile":39848.05,"90th_percentile":39848.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1405.31,"10th_percentile":1405.31,"90th_percentile":1405.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":550.89,"10th_percentile":550.89,"90th_percentile":550.89,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1240.48,"10th_percentile":1240.48,"90th_percentile":1240.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":33830.95,"10th_percentile":33830.95,"90th_percentile":33830.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":1575.0,"10th_percentile":1575.0,"90th_percentile":4364.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":1279.9,"10th_percentile":1279.9,"90th_percentile":1279.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":86.08,"10th_percentile":86.08,"90th_percentile":86.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":86.08,"10th_percentile":86.08,"90th_percentile":1206.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":264.9,"10th_percentile":65.49,"90th_percentile":365.41,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":105.43,"10th_percentile":105.43,"90th_percentile":105.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":257.0,"10th_percentile":257.0,"90th_percentile":257.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":97.7,"10th_percentile":97.7,"90th_percentile":97.7,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":1695.15,"10th_percentile":1181.4,"90th_percentile":2108.89},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":1864.72,"10th_percentile":1864.72,"90th_percentile":1864.72,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"15","median_amount":2552.57,"10th_percentile":1628.12,"90th_percentile":5350.91,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"24","median_amount":1193.6,"10th_percentile":219.13,"90th_percentile":4314.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"47","median_amount":487.78,"10th_percentile":213.94,"90th_percentile":3885.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":160.13,"10th_percentile":124.08,"90th_percentile":309.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":313.88,"10th_percentile":313.88,"90th_percentile":313.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"113","median_amount":216.13,"10th_percentile":22.59,"90th_percentile":512.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"37","median_amount":335.4,"10th_percentile":199.27,"90th_percentile":1022.9,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":522.95,"10th_percentile":522.95,"90th_percentile":522.95,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":348.42,"10th_percentile":212.06,"90th_percentile":867.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":527.16,"10th_percentile":203.41,"90th_percentile":835.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":296.59,"10th_percentile":296.59,"90th_percentile":296.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":583.65,"10th_percentile":210.51,"90th_percentile":1415.25,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":3325.73,"10th_percentile":3296.57,"90th_percentile":4721.96},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":267.06,"10th_percentile":267.06,"90th_percentile":512.5,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":3397.91,"10th_percentile":3397.91,"90th_percentile":4131.26},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"12","median_amount":2518.32,"10th_percentile":1738.46,"90th_percentile":4172.48,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":2968.92,"10th_percentile":2968.92,"90th_percentile":2968.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":5289.89,"10th_percentile":5289.89,"90th_percentile":5289.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Drug Administration","code_information":[{"code":"5694","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":14043.0,"10th_percentile":14043.0,"90th_percentile":14043.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":15521.35,"10th_percentile":15521.35,"90th_percentile":15521.35,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":596.58,"10th_percentile":596.58,"90th_percentile":596.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":2608.42,"10th_percentile":2608.42,"90th_percentile":2778.74,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Diagnostic Tests and Related Services","code_information":[{"code":"5721","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"44","median_amount":1216.0,"10th_percentile":1216.0,"90th_percentile":1261.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"52","median_amount":1132.0,"10th_percentile":1018.8,"90th_percentile":1185.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"28","median_amount":148.11,"10th_percentile":145.23,"90th_percentile":148.11,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"11","median_amount":1368.0,"10th_percentile":1294.4,"90th_percentile":1368.0},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"1 through 10","median_amount":1239.75,"10th_percentile":1239.75,"90th_percentile":1239.75},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"22","median_amount":1090.13,"10th_percentile":872.1,"90th_percentile":1147.5,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":1130.03,"10th_percentile":147.36,"90th_percentile":1189.5,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":3918.53,"10th_percentile":2849.84,"90th_percentile":5699.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":3043.81,"10th_percentile":3043.81,"90th_percentile":7694.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"19","median_amount":2737.67,"10th_percentile":214.56,"90th_percentile":4211.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":2652.93,"10th_percentile":295.27,"90th_percentile":6484.94,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":252.38,"10th_percentile":235.82,"90th_percentile":4008.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":1672.83,"10th_percentile":1672.83,"90th_percentile":1672.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"1 through 10","median_amount":418.67,"10th_percentile":418.67,"90th_percentile":418.67,"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."}]}]},{"description":"Level 3 Diagnostic Tests and Related Services","code_information":[{"code":"5723","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":2947.56,"10th_percentile":2656.17,"90th_percentile":3987.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"14","median_amount":2967.92,"10th_percentile":2602.88,"90th_percentile":5064.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":372.91,"10th_percentile":372.91,"90th_percentile":399.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":502.27,"10th_percentile":502.27,"90th_percentile":502.27,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":228.81,"10th_percentile":228.81,"90th_percentile":759.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":0.42,"10th_percentile":0.42,"90th_percentile":0.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":398.64,"10th_percentile":398.64,"90th_percentile":398.64,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":3732.46,"10th_percentile":3334.78,"90th_percentile":4054.46},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":2982.14,"10th_percentile":2982.14,"90th_percentile":3611.28,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Diagnostic Tests and Related Services","code_information":[{"code":"5724","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"22","median_amount":5264.0,"10th_percentile":4211.2,"90th_percentile":5458.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"36","median_amount":4897.0,"10th_percentile":3917.6,"90th_percentile":5264.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":172.89,"10th_percentile":172.89,"90th_percentile":172.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"88","median_amount":963.07,"10th_percentile":963.07,"90th_percentile":1356.16,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":345.78,"10th_percentile":345.78,"90th_percentile":345.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":777.63,"10th_percentile":777.63,"90th_percentile":777.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":780.41,"10th_percentile":780.41,"90th_percentile":780.41,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":6454.2,"10th_percentile":6379.2,"90th_percentile":6715.2},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"22","median_amount":5083.43,"10th_percentile":4066.74,"90th_percentile":5351.18,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":5269.49,"10th_percentile":5269.49,"90th_percentile":5547.04,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Minor Procedures","code_information":[{"code":"5731","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5.89,"10th_percentile":5.89,"90th_percentile":5.89,"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":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"30","median_amount":5.83,"10th_percentile":5.83,"90th_percentile":11.66,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":221.86,"10th_percentile":43.19,"90th_percentile":372.58,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":5.83,"10th_percentile":5.83,"90th_percentile":5.83,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":178.08,"10th_percentile":178.08,"90th_percentile":178.08,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":838.4,"10th_percentile":838.4,"90th_percentile":838.4,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":4890.62,"10th_percentile":4890.62,"90th_percentile":4890.62,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":4340.1,"10th_percentile":4340.1,"90th_percentile":4404.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":29.88,"10th_percentile":29.88,"90th_percentile":303.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"29","median_amount":225.9,"10th_percentile":112.9,"90th_percentile":411.86,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":90.24,"10th_percentile":90.24,"90th_percentile":90.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":208.04,"10th_percentile":149.1,"90th_percentile":237.76,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":2407.02,"10th_percentile":2407.02,"90th_percentile":2407.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"12","median_amount":1171.62,"10th_percentile":225.63,"90th_percentile":1651.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":508.97,"10th_percentile":192.93,"90th_percentile":7205.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"22","median_amount":86.42,"10th_percentile":11.37,"90th_percentile":225.04,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":57.38,"10th_percentile":56.23,"90th_percentile":510.06,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":11.37,"10th_percentile":11.37,"90th_percentile":50.12,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":26.73,"10th_percentile":26.73,"90th_percentile":40.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":55.03,"10th_percentile":55.03,"90th_percentile":55.03,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":33.89,"10th_percentile":33.89,"90th_percentile":33.89,"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","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":224.9,"10th_percentile":56.23,"90th_percentile":314.86,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":313.92,"10th_percentile":313.92,"90th_percentile":313.92},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":11.37,"10th_percentile":11.37,"90th_percentile":195.93,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":245.25,"10th_percentile":245.25,"90th_percentile":245.25},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":261.6,"10th_percentile":261.6,"90th_percentile":35224.62,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":12910.52,"10th_percentile":12910.52,"90th_percentile":12910.52,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":81.36,"10th_percentile":81.36,"90th_percentile":890.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":764.33,"10th_percentile":75.69,"90th_percentile":18406.75,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":134.63,"10th_percentile":134.63,"90th_percentile":134.63,"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":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":94.02,"10th_percentile":94.02,"90th_percentile":94.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"236","median_amount":135.04,"10th_percentile":21.03,"90th_percentile":248.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"78","median_amount":132.87,"10th_percentile":122.02,"90th_percentile":159.4,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":141.38,"10th_percentile":141.38,"90th_percentile":461.9,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"15","median_amount":163.28,"10th_percentile":11.19,"90th_percentile":240.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":147.0,"10th_percentile":118.28,"90th_percentile":307.68,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":135.0,"10th_percentile":135.0,"90th_percentile":135.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":2554.72,"10th_percentile":2554.72,"90th_percentile":43819.78,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":27267.52,"10th_percentile":27267.52,"90th_percentile":27267.52,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":26.7,"10th_percentile":26.7,"90th_percentile":26.7,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":382.0,"10th_percentile":382.0,"90th_percentile":382.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Electronic Analysis of Devices","code_information":[{"code":"5741","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":197.65,"10th_percentile":197.65,"90th_percentile":231.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"115","median_amount":231.15,"10th_percentile":118.59,"90th_percentile":247.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"119","median_amount":197.65,"10th_percentile":149.86,"90th_percentile":211.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"109","median_amount":15.7,"10th_percentile":15.7,"90th_percentile":18.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1215","median_amount":35.5,"10th_percentile":25.5,"90th_percentile":35.8,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"14","median_amount":15.69,"10th_percentile":15.46,"90th_percentile":15.83,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"35","median_amount":15.7,"10th_percentile":15.7,"90th_percentile":17.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"61","median_amount":28.24,"10th_percentile":28.05,"90th_percentile":35.3,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"71","median_amount":28.24,"10th_percentile":28.05,"90th_percentile":28.24,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"19","median_amount":321.6,"10th_percentile":283.2,"90th_percentile":412.0},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"1 through 10","median_amount":35.3,"10th_percentile":35.3,"90th_percentile":35.3},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":251.25,"10th_percentile":236.25,"90th_percentile":360.0},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"72","median_amount":268.0,"10th_percentile":214.4,"90th_percentile":282.4,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":211.73,"10th_percentile":54.03,"90th_percentile":265.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"1 through 10","median_amount":170.18,"10th_percentile":170.18,"90th_percentile":179.32},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Rehabilitation","code_information":[{"code":"5771","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"29","median_amount":1302.0,"10th_percentile":434.0,"90th_percentile":2025.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"20","median_amount":1015.0,"10th_percentile":406.0,"90th_percentile":1827.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":139.32,"10th_percentile":139.32,"90th_percentile":139.32,"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":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":341.45,"10th_percentile":273.16,"90th_percentile":459.48,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"116","median_amount":834.33,"10th_percentile":238.98,"90th_percentile":1167.72,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"11","median_amount":269.16,"10th_percentile":131.28,"90th_percentile":590.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":572.1,"10th_percentile":381.4,"90th_percentile":762.8,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":786.24,"10th_percentile":385.3,"90th_percentile":1081.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":2580.48,"10th_percentile":860.16,"90th_percentile":4300.8},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"13","median_amount":1716.0,"10th_percentile":685.44,"90th_percentile":2704.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":2325.05,"10th_percentile":2325.05,"90th_percentile":2325.05,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"12","median_amount":2159.23,"10th_percentile":1814.54,"90th_percentile":5471.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"11","median_amount":1585.44,"10th_percentile":1076.76,"90th_percentile":3343.98,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"17","median_amount":370.19,"10th_percentile":156.92,"90th_percentile":448.19,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"59","median_amount":1138.86,"10th_percentile":605.17,"90th_percentile":1517.05,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":484.06,"10th_percentile":484.06,"90th_percentile":484.06,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1146.53,"10th_percentile":1146.53,"90th_percentile":1146.53,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":5390.11,"10th_percentile":3105.27,"90th_percentile":6472.11},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":4363.7,"10th_percentile":4363.7,"90th_percentile":4363.7},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":2172.96,"10th_percentile":1633.03,"90th_percentile":3560.78,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":6649.31,"10th_percentile":6649.31,"90th_percentile":6937.8,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":943.61,"10th_percentile":855.09,"90th_percentile":1575.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":1428.0,"10th_percentile":1372.28,"90th_percentile":2915.03,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":92.05,"10th_percentile":92.05,"90th_percentile":139.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"38","median_amount":112.73,"10th_percentile":78.44,"90th_percentile":258.42,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":264.9,"10th_percentile":264.9,"90th_percentile":264.9,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":110.61,"10th_percentile":92.05,"90th_percentile":212.69,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":92.05,"10th_percentile":92.05,"90th_percentile":228.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":503.96,"10th_percentile":503.96,"90th_percentile":503.96,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":265.27,"10th_percentile":265.27,"90th_percentile":265.27,"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":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":88.13,"10th_percentile":88.13,"90th_percentile":88.13,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":1862.31,"10th_percentile":1862.31,"90th_percentile":1913.29},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":1303.17,"10th_percentile":1303.17,"90th_percentile":1303.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Health and Behavior Services","code_information":[{"code":"5821","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2186.77,"10th_percentile":2186.77,"90th_percentile":2186.77,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":1207.53,"10th_percentile":1207.53,"90th_percentile":1207.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Health and Behavior Services","code_information":[{"code":"5823","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"28","median_amount":2712.5,"10th_percentile":1354.9,"90th_percentile":4664.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"14","median_amount":3732.3,"10th_percentile":2446.81,"90th_percentile":3973.72,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":135.13,"10th_percentile":92.71,"90th_percentile":183.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":354.7,"10th_percentile":354.7,"90th_percentile":354.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"99","median_amount":216.45,"10th_percentile":112.74,"90th_percentile":290.14,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":557.97,"10th_percentile":416.69,"90th_percentile":732.46,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":257.04,"10th_percentile":239.26,"90th_percentile":322.35,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"19","median_amount":259.02,"10th_percentile":215.38,"90th_percentile":331.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":313.78,"10th_percentile":167.27,"90th_percentile":472.57,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":64.89,"10th_percentile":64.89,"90th_percentile":64.89,"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","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":323.9,"10th_percentile":268.64,"90th_percentile":585.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":444.14,"10th_percentile":331.35,"90th_percentile":733.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":3716.16,"10th_percentile":2896.35,"90th_percentile":4522.56},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"1 through 10","median_amount":2019.2,"10th_percentile":2019.2,"90th_percentile":2019.2},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"19","median_amount":267.92,"10th_percentile":200.31,"90th_percentile":423.37,"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":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"14","median_amount":3003.24,"10th_percentile":1521.0,"90th_percentile":4896.13},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":2010.9,"10th_percentile":1593.21,"90th_percentile":4667.97,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"1 through 10","median_amount":2630.51,"10th_percentile":2630.51,"90th_percentile":2630.51,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":2768.36,"10th_percentile":2768.36,"90th_percentile":2768.36,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, bupivacaine, nos, 0.5mg","code_information":[{"code":"9290","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"1 through 10","median_amount":5049.05,"10th_percentile":5049.05,"90th_percentile":5049.05,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":9.9,"10th_percentile":9.9,"90th_percentile":9.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"RBC leukoreduced irradiated","code_information":[{"code":"9522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":915.2,"10th_percentile":915.2,"90th_percentile":1274.36,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Plate pheres leukoredu irrad","code_information":[{"code":"9530","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1306.04,"10th_percentile":1062.61,"90th_percentile":2511.6,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"22","median_amount":2668.07,"10th_percentile":2158.37,"90th_percentile":3491.45,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Plt, pher, l/r cmv-neg, irr","code_information":[{"code":"9531","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":4000.94,"10th_percentile":4000.67,"90th_percentile":4229.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":211.26,"10th_percentile":211.26,"90th_percentile":211.26,"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":122.9,"10th_percentile":122.9,"90th_percentile":122.9,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"61","median_amount":172.28,"10th_percentile":27.32,"90th_percentile":710.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"46","median_amount":255.0,"10th_percentile":70.0,"90th_percentile":836.76,"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":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"15","median_amount":50.16,"10th_percentile":8.46,"90th_percentile":118.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"127","median_amount":49.12,"10th_percentile":8.54,"90th_percentile":183.11,"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":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"11359","median_amount":34.78,"10th_percentile":8.17,"90th_percentile":142.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19265","median_amount":22.65,"10th_percentile":5.45,"90th_percentile":64.12,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"289","median_amount":28.0,"10th_percentile":9.71,"90th_percentile":120.64,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1258","median_amount":32.84,"10th_percentile":8.46,"90th_percentile":118.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1158","median_amount":23.08,"10th_percentile":6.63,"90th_percentile":79.9,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"157","median_amount":24.76,"10th_percentile":8.88,"90th_percentile":112.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1076","median_amount":27.4,"10th_percentile":7.91,"90th_percentile":87.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":1023.36,"10th_percentile":183.48,"90th_percentile":1992.96},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"1 through 10","median_amount":87.87,"10th_percentile":87.87,"90th_percentile":87.87},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"56","median_amount":47.32,"10th_percentile":8.44,"90th_percentile":90.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":180.75,"10th_percentile":115.5,"90th_percentile":639.75},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"28","median_amount":133.6,"10th_percentile":19.19,"90th_percentile":887.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"38","median_amount":98.85,"10th_percentile":28.85,"90th_percentile":442.81,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":377.1,"10th_percentile":173.51,"90th_percentile":715.3,"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":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Therapy Services","code_information":[{"code":"N801","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"39","median_amount":541.0,"10th_percentile":486.0,"90th_percentile":1065.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"46","median_amount":763.2,"10th_percentile":452.0,"90th_percentile":1027.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":125.52,"10th_percentile":125.52,"90th_percentile":125.52,"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":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":205.98,"10th_percentile":205.98,"90th_percentile":270.94,"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":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"124","median_amount":127.08,"10th_percentile":62.66,"90th_percentile":255.72,"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":"Dean 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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":194.42,"10th_percentile":127.08,"90th_percentile":609.42,"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":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"1 through 10","median_amount":1589.76,"10th_percentile":1536.0,"90th_percentile":3721.92},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"1 through 10","median_amount":710.0,"10th_percentile":459.0,"90th_percentile":1578.21,"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":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"17","median_amount":702.6,"10th_percentile":127.74,"90th_percentile":1997.58,"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":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"1 through 10","median_amount":1303.0,"10th_percentile":1216.0,"90th_percentile":1351.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":42.25,"10th_percentile":42.25,"90th_percentile":42.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Not Recognized by OPPS","code_information":[{"code":"N905","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 13543] [Cardiac Cath ($): 16815] [Lithotripsy ($): 22455] [PTCA ($): 36101] [Observation ($): 12380] [ED Level 1--99281 ($): 391] [ED Level 2--99282 ($): 391] [ED Level 3--99283 ($): 1575] [ED Level 4--99284 ($): 4664] [ED Level 5--99285 ($): 4664] [Critical Care-99291 ($): 7178] [Urgent Care ($): 421] [Cardiac Rehabilitation Therapy ($): 217] [Sleep Studies-Attended ($): 5264] [Sleep Studies-Unattended ($): 1216] [CT Scan OP ($): 3426] [MRI OP ($): 4514] [Mammography-Diagnostic ($): 435] [Mammography-Screening ($): 435] [Positron Emission Tomography ($): 5669] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1303] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 486] [Physical Therapy ($): 541] [Speech Therapy ($): 736] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 69] [All Other OP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 12204] [Cardiac Cath ($): 17141] [Lithotripsy ($): 22891] [PTCA ($): 36800] [Observation ($): 10493] [ED Level 1--99281 ($): 365] [ED Level 2--99282 ($): 365] [ED Level 3--99283 ($): 1364] [ED Level 4--99284 ($): 3961] [ED Level 5--99285 ($): 3961] [Critical Care-99291 ($): 7205] [Urgent Care ($): 392] [Cardiac Rehabilitation Therapy ($): 203] [Sleep Studies-Attended ($): 4897] [Sleep Studies-Unattended ($): 1132] [CT Scan OP ($): 3189] [MRI OP ($): 4197] [Mammography-Diagnostic ($): 405] [Mammography-Screening ($): 405] [Positron Emission Tomography ($): 5274] [Radiology Fee Schedule: FEE SCHEDULE] [Ultrasound Imaging ($): 1216] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Occupational Therapy ($): 452] [Physical Therapy ($): 504] [Speech Therapy ($): 686] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 59] [All Other OP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 4977] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 30942] [Insertion of Permanent Pacemaker ($): 26465] [Joint Replacement-Full/Partial ($): 19772] [PTCA w/ Drug Eluting Stent ($): 28782] [PTCA w/non Drug Eluting Stent ($): 28518] [PTCA w/out stent ($): 23777] [Stereotactic Radiosurgery (%BC): 83] [Stereotactic Radiosurgery-Fractionated (%BC): 83] [Observation ($): 13047] [ED Level 1--99281 ($): 683] [ED Level 2--99282 ($): 693] [ED Level 3--99283 ($): 3455] [ED Level 4--99284 ($): 4246] [ED Level 5--99285 ($): 5449] [Critical Care ($): 7359] [Urgent Care (%BC): 83] [Cardiac Rehabilitation Therapy ($): 304] [Cardiac Stress Test ($): 862] [Cardiology ($): 511] [Echocardiology ($): 2170] [EKG/ECG ($): 205] [Electrophysiology ($): 18739] [Electrophysiology Ablation ($): 60132] [Electrophysiology and Mapping Studies ($): 51333] [Holter Monitor/Telemetry ($): 1322] [Peripheral Vascular Lab ($): 1200] [EEG ($): 1199] [EMG (%BC): 83] [MEG (%BC): 83] [Neuropsychological Testing and Biofeedback ($): 364] [Sleep Studies-Attended ($): 4700] [Sleep Studies-Unattended ($): 1030] [Chemotherapy ($): 687] [Nuclear Medicine ($): 3288] [Oncology (%BC): 83] [Radiation Therapy  (%BC): 83] [CT Scan OP ($): 2542] [MRI OP ($): 2904] [Imaging Services ($): 436] [Mammography-Diagnostic ($): 327] [Mammography-Screening ($): 327] [Positron Emission Tomography ($): 5790] [Radiology ($): 462] [Ultrasound Imaging ($): 820] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 807] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 83] [Occupational Therapy ($): 420] [Physical Therapy ($): 469] [Respiratory Services/Therapy  (%BC): 272] [Speech Therapy ($): 616] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 1000 (%BC): 55] [Ambulance--Air  (%BC): 83] [Ambulance--Land  (%BC): 83] [Hyperbarics (%BC): 83] [IV Therapy ($): 349] [Pulmonary Function ($): 1189] [Pulmonary Rehabilitation ($): 136] [All Other OP (%BC): 83]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":63.95,"10th_percentile":63.95,"90th_percentile":76.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":102.32,"10th_percentile":86.44,"90th_percentile":112.54,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"1 through 10","median_amount":63.95,"10th_percentile":63.95,"90th_percentile":80.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":99.26,"10th_percentile":99.26,"90th_percentile":99.26,"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":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 76.5] [Observation (%BC): 76.5] [Emergency Department (%BC): 76.5] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 76.5] [Physical Therapy (%BC): 76.5] [Respiratory Services/Therapy  (%BC): 76.5] [Speech Therapy (%BC): 76.5] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 76.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 79.3] [Observation (%BC): 79.3] [Emergency Department (%BC): 79.3] [Occupational Therapy (%BC): 79.3] [Physical Therapy (%BC): 79.3] [Respiratory Services/Therapy  (%BC): 79.3] [Speech Therapy (%BC): 79.3] [All Other OP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 64.8] [Observation (%BC): 64.8] [Emergency Department (%BC): 64.8] [Occupational Therapy (%BC): 64.8] [Physical Therapy (%BC): 64.8] [Respiratory Services/Therapy  (%BC): 64.8] [Speech Therapy (%BC): 64.8] [OP High Cost Drugs (%BC): 60.1] [All Other OP (%BC): 64.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 74.2] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Occupational Therapy (%BC): 74.2] [Physical Therapy (%BC): 74.2] [Respiratory Services/Therapy  (%BC): 74.2] [Speech Therapy (%BC): 74.2] [OP High Cost Drugs (%BC): 69.6] [All Other OP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Mcc","code_information":[{"code":"077","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11390.18,"10th_percentile":11390.18,"90th_percentile":11390.18,"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":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Or Device Replacement With Mcc","code_information":[{"code":"210","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis With Cc/Mcc","code_information":[{"code":"294","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System O.R. Procedures With Mcc","code_information":[{"code":"361","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection","code_information":[{"code":"400","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Or Knee Procedures With Principal Diagnosis Of Periprosthetic Joint Infection With Mcc Or Insert","code_information":[{"code":"403","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Prosthesis","code_information":[{"code":"449","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Mcc","code_information":[{"code":"453","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Arthroscopy","code_information":[{"code":"509","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Or Complex Spinal Fusion Procedures Except Cervical With Mcc","code_information":[{"code":"523","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Malignancy With Mcc","code_information":[{"code":"731","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Principal Diagnosis Invalid As Discharge Diagnosis","code_information":[{"code":"998","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 12 days | Excess % of Charge: 7400] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE Days: 12] [C-Section 4 day stay-Case Rate: 20116 Days: 4 Additional Days: 1563] [Normal vag. Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":96.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":87.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":99.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges < BasePayment | Total % of Charge: 98] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19935 Days: 4 Additional Days: 1750] [Normal vag. Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 1.811 | Excess % of Charge: 61.1] [Lesser Than Charges paid at %: 93.2] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[IP High Cost Drugs (%BC): 69.6] [All Other IP (%BC): 74.2]","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":"BCBS","plan_name":"Anthem Blue Traditional Traditional","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 9851] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 22805 Days: 4 Additional Days: 1955] [Normal vag. Del. 4 day stay-Case Rate: 15637 Days: 4 Additional Days: 1955] [Normal Newborn-Per Diem: 1824] [Lower Level Neonate-Per Diem: 4360] [Higher Level Neonate-Per Diem: 7042] [Severe Level Neonate-per diem: 7042] [Rehab (%BC): 69] [All Other IP (%BC): 69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 6596] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 20371 Days: 4 Additional Days: 2099] [Normal vag. Del. 4 day stay-Case Rate: 11286 Days: 4 Additional Days: 2099] [Normal Newborn-Per Diem: 1680] [Lower Level Neonate-Per Diem: 3673] [Higher Level Neonate-Per Diem: 6525] [Severe Level Neonate-per diem: 6525] [Rehab (%BC): 59] [All Other IP (%BC): 59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 11204 Days: 2 Additional Days: 1563] [Normal Newborn-Per Diem: 1571] [Lower Level Neonate-Per Diem: 2948] [Higher Level Neonate-Per Diem: 4018] [Severe Level Neonate-per diem: 4365] [Psych-Per Diem: 1822] [Rehab-Per Diem: 2283] [Burn  (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.dhs.wisconsin.gov/medicaid/index.htm]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 11262 Days: 2 Additional Days: 1750] [Normal Newborn-Per Diem: 1450] [Lower Level Neonate-Per Diem: 3150] [Higher Level Neonate-Per Diem: 3460] [Severe Level Neonate-per diem: 5230] [All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 79.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":50.8,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 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is presented in the standard charge value."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Bilateral Procedure","code":"50","modifier_payer_information":[{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Distinct Procedural Service","code":"59","modifier_payer_information":[{"payer_name":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","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":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","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":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","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":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","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":"BCBS","plan_name":"Blue Preferred/Blue Preferred Plus HMO/POS","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Blue Access PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Blue Traditional Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centivo","plan_name":"Broad(WI2) Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"WPS","plan_name":"Southern Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Centene","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Chorus","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Dean Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Eye Quest","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"FABOH","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"GHC EAU CLAIRE","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"GHC-Eau Claire","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"ICare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Managed Health Services","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Aetna All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Complementary All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"Health EOS All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PHCS All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"UHC All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quartz","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Quartz","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Options PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Plan of the River Valley Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Workers Comp","plan_name":"Workers Compensation Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"WPS","plan_name":"Statewide Other Commercial Plan","description":"The modified price is presented in the standard charge value."}]},{"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":"Dean Health Plan","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"ICare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]}]}